Concurrent CNS tumors and multiple sclerosis: retrospective single-center cohort study and lessons for the clinical management

Primary central nervous system tumors in patients with multiple sclerosis

BACKGROUND

Multiple sclerosis (MS) is a chronic neuroinflammatory disorder that can present with clinical and radiological features indistinguishable from a central nervous system (CNS) tumor. Previous studies suggest that whilepatients with MS have a reduced overall risk of cancer, they may have an increased risk of developing CNS malignancies.

METHODS

In this cross-sectional observational study, we investigated the prevalence of CNS tumors in patients with MS using data from the Isfahan MS clinic registry between 2020 and 2023 who had been diagnosed with primary CNS tumors following their diagnosis of MS.

RESULTS

Among the 2,280 registered patients, 36 individuals were diagnosed with CNS tumors, yielding a prevalence of 1.58%. The distribution of primary CNS tumors among these patients was as follows: 41.7% had pituitary adenomas, 30.6% had meningiomas, 13.9% had primary CNS lymphoma, 5.6% had acoustic neuroma, and the remaining cases included epidermoid cysts (2.8%), neurofibromas (2.8%), and glioblastoma multiforme (2.8%). The mean age at tumor diagnosis was approximately 45 years, while the mean age at MS diagnosis among those who subsequently developed a CNS tumor was 31.5 years.

CONCLUSION

The overall prevalence of primary CNS tumors in our MS population was 1.58%. Meningiomas and pituitary adenomas were the most common types of CNS tumors observed in these patients. Given potential symptom overlap, new or unusual symptoms not typical of MS should be closely monitored or assessed for possible CNS malignancies.

Multiple sclerosis and cancer: Navigating a dual diagnosis

Healthcare breakthroughs are extending the lives of multiple sclerosis (MS) patients and cancer survivors, creating a growing cohort of individuals navigating a dual diagnosis. Determining the relationship between MS and cancer risk remains challenging, with inconclusive findings confounded by age, risk exposures, comorbidities, genetics and the ongoing introduction of new MS disease-modifying therapies (DMTs) across study periods.This research places significant emphasis on cancer survival, with less attention given to the impact on MS outcomes. Our review explores the existing literature on MS, cancer risk and the intersection of DMTs and cancer treatments. We aim to navigate the complexities of managing MS in cancer survivors to optimise outcomes for both conditions. Continuous research and the formulation of treatment guidelines are essential for guiding future care. Collaboration between neuro-immunology and oncology is crucial, with a need to establish databases for retrospective and ultimately prospective analysis of outcomes in these rapidly evolving fields.

Cancer and multiple sclerosis: 2023 recommendations from the French Multiple Sclerosis Society

BACKGROUND

Epidemiological data reveal that 45% of persons with multiple sclerosis (PwMS) in France are more than 50 years. This population more than 50 is more susceptible to cancer, and this risk may be increased by frequent use of immunosuppressive drugs. Consequently, concerns have arisen about the potential increased risk of cancer in PwMS and how patients should be screened and managed in terms of cancer risk.

OBJECTIVE

To develop evidence-based recommendations to manage the coexistence of cancer and multiple sclerosis (MS).

METHODS

The French Group for Recommendations in MS collected articles from PubMed and university databases covering the period January 1975 through June 2022. The RAND/UCLA method was employed to achieve formal consensus. MS experts comprehensively reviewed the full-text articles and developed the initial recommendations. A group of multidisciplinary health care specialists then validated the final proposal.

RESULTS

Five key questions were addressed, encompassing various topics such as cancer screening before or after initiating a disease-modifying therapy (DMT), appropriate management of MS in the context of cancer, recommended follow-up for cancer in patients receiving a DMT, and the potential reintroduction of a DMT after initial cancer treatment. A strong consensus was reached for all 31 recommendations.

CONCLUSION

These recommendations propose a strategic approach to managing cancer risk in PwMS.