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Fanizza J, Bencardino S, Allocca M, Furfaro F, Zilli A, Parigi TL, Fiorino G, Peyrin-Biroulet L, Danese S, D'Amico F. Inflammatory Bowel Disease and Colorectal Cancer. Cancers (Basel) 2024; 16:2943. [PMID: 39272800 PMCID: PMC11394070 DOI: 10.3390/cancers16172943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024] Open
Abstract
Patients with inflammatory bowel diseases (IBDs), including both ulcerative colitis (UC) and Crohn's disease (CD), are at a higher risk of developing colorectal cancer (CRC). However, advancements in endoscopic imaging techniques, integrated surveillance programs, and improved medical therapies have led to a decrease in the incidence of CRC among IBD patients. Currently, the management of patients with IBD who have a history of or ongoing active malignancy is an unmet need. This involves balancing the risk of cancer recurrence/progression with the potential exacerbation of IBD if the medications are discontinued. The objective of this review is to provide an updated summary of the epidemiology, causes, risk factors, and surveillance approaches for CRC in individuals with IBD, and to offer practical guidance on managing IBD patients with history of previous or active cancer.
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Affiliation(s)
- Jacopo Fanizza
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Sarah Bencardino
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Federica Furfaro
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alessandra Zilli
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Tommaso Lorenzo Parigi
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Gionata Fiorino
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- INSERM, NGERE, University of Lorraine, F-54000 Nancy, France
- INFINY Institute, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- Groupe Hospitalier Privè Ambroise Parè-Hartmann, Paris IBD Center, 92200 Neuilly sur Seine, France
- Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Ferdinando D'Amico
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy
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Axelrad JE, Hashash JG, Itzkowitz SH. AGA Clinical Practice Update on Management of Inflammatory Bowel Disease in Patients With Malignancy: Commentary. Clin Gastroenterol Hepatol 2024; 22:1365-1372. [PMID: 38752967 DOI: 10.1016/j.cgh.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/16/2024] [Accepted: 03/25/2024] [Indexed: 06/23/2024]
Abstract
DESCRIPTION The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update (CPU) Commentary is to discuss the risks of various malignancies in patients with inflammatory bowel diseases (IBD) and the impact of the available medical therapies on these risks. The CPU will also guide the approach to the patient with IBD who develops a malignancy or the patient with a history of cancer in terms of IBD medication management. METHODS This CPU was commissioned and approved by the AGA Institute CPU committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPU committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. This communication incorporates important and recently published studies in the field, and it reflects the experiences of the authors who are experts in the diagnosis and management of IBD.
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Affiliation(s)
- Jordan E Axelrad
- Inflammatory Bowel Disease Center at NYU Langone Health, Division of Gastroenterology, NYU Grossman School of Medicine, New York, New York.
| | - Jana G Hashash
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Steven H Itzkowitz
- Division of Gastroenterology, the Icahn School of Medicine at Mount Sinai, New York, New York
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Zhou S, Yu J. Crohn's disease and breast cancer: a literature review of the mechanisms and treatment. Intern Emerg Med 2023; 18:1303-1316. [PMID: 37138170 PMCID: PMC10412481 DOI: 10.1007/s11739-023-03281-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/14/2023] [Indexed: 05/05/2023]
Abstract
This is a literature review describes Crohn's disease (CD) concomitant with breast cancer and summarizes possible common pathogenic mechanisms shared by the two diseases involving the IL-17 and NF-κB signaling pathways. Inflammatory cytokines including TNF-α and Th17 cells in CD patients can induce activation of the ERK1/2, NF-κB and Bcl-2 pathways. Hub genes are involved in the generation of cancer stem cells (CSCs) and are related to inflammatory mediators, including CXCL8, IL1-β and PTGS2, which promote inflammation and breast cancer growth, metastasis, and development. CD activity is highly associated with altered intestinal microbiota processes, including secretion of complex glucose polysaccharides by Ruminococcus gnavus colonies; furthermore, γ-proteobacteria and Clostridium are associated with CD recurrence and active CD, while Ruminococcaceae, Faecococcus and Vibrio desulfuris are associated with CD remission. Intestinal microbiota disorder promotes breast cancer occurrence and development. Bacteroides fragilis can produce toxins that induce breast epithelial hyperplasia and breast cancer growth and metastasis. Gut microbiota regulation can also improve chemotherapy and immunotherapy efficacy in breast cancer treatment. Intestinal inflammation can affects the brain through the brain-gut axis, which activates the hypothalamic‒pituitary‒adrenal (HPA) axis to induce anxiety and depression in patients; these effects can inhibit the antitumor immune responses of the immune system and promote breast cancer occurrence in patients with CD. There are few studies on the treatment of patients with CD concomitant with breast cancer, but published studies show three main strategies: new biological agents combined with breast cancer treatment methods, intestinal fecal bacteria transplantation, and dietary treatment.
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Affiliation(s)
- Sisi Zhou
- Department of Gastroenterology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, China
| | - Jing Yu
- Department of Gastroenterology, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, China.
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Conceição D, Saraiva MR, Rosa I, Claro I. Inflammatory Bowel Disease Treatment in Cancer Patients-A Comprehensive Review. Cancers (Basel) 2023; 15:3130. [PMID: 37370740 DOI: 10.3390/cancers15123130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic disease for which medical treatment with immunomodulating drugs is increasingly used earlier to prevent disability. Additionally, cancer occurrence in IBD patients is increased for several reasons, either IBD-related or therapy-associated. Doctors are therefore facing the challenge of managing patients with IBD and a past or current malignancy and the need to balance the risk of cancer recurrence associated with immunosuppressive drugs with the potential worsening of IBD activity if they are withdrawn. This review aims to explore the features of different subtypes of cancer occurring in IBD patients to present current evidence on malignancy recurrence risk associated with IBD medical therapy along with the effects of cancer treatment in IBD and finally to discuss current recommendations on the management of these patients. Due to sparse data, a case-by-case multidisciplinary discussion is advised, including inputs from the gastroenterologist, oncologist, and patient.
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Affiliation(s)
- Daniel Conceição
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisboa, Portugal
| | - Margarida R Saraiva
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisboa, Portugal
| | - Isadora Rosa
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisboa, Portugal
| | - Isabel Claro
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisboa, Portugal
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Peixoto RD, Ferreira AR, Cleary JM, Fogacci JP, Vasconcelos JP, Jácome AA. Risk of Cancer in Inflammatory Bowel Disease and Pitfalls in Oncologic Therapy. J Gastrointest Cancer 2023; 54:357-367. [PMID: 35288863 DOI: 10.1007/s12029-022-00816-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD), represented by ulcerative colitis and Crohn's disease, is an idiopathic condition caused by a dysregulated immune response to host intestinal microflora, leading to chronic relapsing intestinal inflammation. Individuals with IBD are more prone to die from several diseases, including cancer. METHODS An extensive search was conducted of PubMed using the following medical subject heading-"inflammatory bowel disease" OR "Crohn's disease" OR "ulcerative colitis" AND "cancer." RESULTS In this review article, we discuss the oncogenic mechanisms and genomics of colitis-associated colorectal cancer. Beyond this, we describe the multiple other malignancies that IBD patients are at risk for, discuss caveats in the screening and diagnosis of those cancers, and shed light on pitfalls on the management and treatment of cancer in IBD patients. CONCLUSION Patients, caregivers, and health professionals who deal with IBD must be educated on how to identify warning signs so that cancers can be diagnosed and treated as early as possible.
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Holmer AK, Luo J, Russ KB, Park S, Yang JY, Ertem F, Dueker J, Nguyen V, Hong S, Zenger C, Axelrad JE, Sofia A, Petrov JC, Al-Bawardy B, Fudman DI, Llano E, Dailey J, Jangi S, Khakoo N, Damas OM, Barnes EL, Scott FI, Ungaro RC, Singh S. Comparative Safety of Biologic Agents in Patients With Inflammatory Bowel Disease With Active or Recent Malignancy: A Multi-Center Cohort Study. Clin Gastroenterol Hepatol 2023; 21:1598-1606.e5. [PMID: 36642291 DOI: 10.1016/j.cgh.2023.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/24/2022] [Accepted: 01/05/2023] [Indexed: 01/17/2023]
Abstract
BACKGROUND & AIMS Safety of biologic agents is a key consideration in patients with inflammatory bowel disease (IBD) and active or recent cancer. We compared the safety of tumor necrosis factor (TNF)-α antagonists vs non-TNF biologics in patients with IBD with active or recent cancer. METHODS We conducted a multicenter retrospective cohort study of patients with IBD and either active cancer (cohort A) or recent prior cancer (within ≤5 years; cohort B) who were treated with TNFα antagonists or non-TNF biologics after their cancer diagnosis. Primary outcomes were progression-free survival (cohort A) or recurrence-free survival (cohort B). Safety was compared using inverse probability of treatment weighting with propensity scores. RESULTS In cohort A, of 125 patients (483.8 person-years of follow-up evaluation) with active cancer (age, 54 ± 15 y, 75% solid-organ malignancy), 10 of 55 (incidence rate [IR] per 100 py, 4.4) and 9 of 40 (IR, 10.4) patients treated with TNFα antagonists and non-TNF biologics had cancer progression, respectively. There was no difference in the risk of progression-free survival between TNFα antagonists vs non-TNF biologics (hazard ratio, 0.76; 95% CI, 0.25-2.30). In cohort B, of 170 patients (513 person-years of follow-up evaluation) with recent prior cancer (age, 53 ± 15 y, 84% solid-organ malignancy; duration of remission, 19 ± 19 mo), 8 of 78 (IR, 3.4) and 5 of 66 (IR 3.7) patients treated with TNFα antagonists and non-TNF biologics had cancer recurrence, respectively. The risk of recurrence-free survival was similar between both groups (hazard ratio, 0.94; 95% CI, 0.24-3.77). CONCLUSIONS In patients with IBD with active or recent cancer, TNFα antagonists and non-TNF biologics have comparable safety. The choice of biologic should be dictated by IBD disease severity in collaboration with an oncologist.
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Affiliation(s)
- Ariela K Holmer
- Division of Gastroenterology, New York University Langone Health, New York, New York; Division of Gastroenterology, University of California San Diego, La Jolla, California.
| | - Jiyu Luo
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Kirk B Russ
- Division of Gastroenterology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sarah Park
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeong Yun Yang
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Furkan Ertem
- Division of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jeffrey Dueker
- Division of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Vu Nguyen
- Division of Gastroenterology, Case Western Reserve University, Cleveland, Ohio
| | - Simon Hong
- Division of Gastroenterology, New York University Langone Health, New York, New York
| | - Cameron Zenger
- Department of Medicine, New York University Langone Medical Center, New York, New York
| | - Jordan E Axelrad
- Division of Gastroenterology, New York University Langone Health, New York, New York
| | - Anthony Sofia
- Division of Gastroenterology, Oregon Health and Science University, Portland, Oregon
| | - Jessica C Petrov
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut
| | - Badr Al-Bawardy
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut
| | - David I Fudman
- Division of Gastroenterology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ernesto Llano
- Division of Gastroenterology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joseph Dailey
- Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts
| | - Sushrut Jangi
- Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts
| | - Nidah Khakoo
- Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Oriana M Damas
- Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Frank I Scott
- Division of Gastroenterology and Hepatology, University of Colorado, Aurora, Colorado
| | - Ryan C Ungaro
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
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Jeon SR. The Impact of Cancer Treatments on the Disease Activity of Inflammatory Bowel Diseases. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2023. [DOI: 10.4166/kjg.2023.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Wetwittayakhlang P, Tselekouni P, Al-Jabri R, Bessissow T, Lakatos PL. The Optimal Management of Inflammatory Bowel Disease in Patients with Cancer. J Clin Med 2023; 12:jcm12062432. [PMID: 36983432 PMCID: PMC10056442 DOI: 10.3390/jcm12062432] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/11/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) have an increased risk of cancer secondary to chronic inflammation and long-term use of immunosuppressive therapy. With the aging IBD population, the prevalence of cancer in IBD patients is increasing. As a result, there is increasing concern about the impact of IBD therapy on cancer risk and survival, as well as the effects of cancer therapies on the disease course of IBD. Managing IBD in patients with current or previous cancer is challenging since clinical guidelines are based mainly on expert consensus. Evidence is rare and mainly available from registries or observational studies. In contrast, excluding patients with previous/or active cancer from clinical trials and short-term follow-up can lead to an underestimation of the cancer or cancer recurrence risk of approved medications. The present narrative review aims to summarize the current evidence and provide practical guidance on the management of IBD patients with cancer.
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Affiliation(s)
- Panu Wetwittayakhlang
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand
| | - Paraskevi Tselekouni
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Reem Al-Jabri
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Talat Bessissow
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Peter L Lakatos
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Department of Internal Medicine and Oncology, Semmelweis University, 1085 Budapest, Hungary
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Laredo V, García-Mateo S, Martínez-Domínguez SJ, López de la Cruz J, Gargallo-Puyuelo CJ, Gomollón F. Risk of Cancer in Patients with Inflammatory Bowel Diseases and Keys for Patient Management. Cancers (Basel) 2023; 15:871. [PMID: 36765829 PMCID: PMC9913122 DOI: 10.3390/cancers15030871] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023] Open
Abstract
Chronic inflammation in patients with Inflammatory Bowel Disease (IBD) leads to an increased risk of colorectal cancer, small bowel cancer, intestinal lymphoma and cholangiocarcinoma. However, treatments for IBD have also been associated with an increased risk of neoplasms. Patients receiving Thiopurines (TPs) have an increased risk of hematologic malignancies, non-melanoma skin cancer, urinary tract neoplasms and cervical cancer. Anti-TNFs have been associated with a higher risk of neoplasms, mainly lymphomas and melanomas; however, the data are controversial, and some recent studies do not confirm the association. Nevertheless, other biologic agents, such as ustekinumab and vedolizumab, have not shown an increased risk of any neoplasm to date. The risk of malignancies with tofacitinib exists, but its magnitude and relationship with previous treatment with TPs is not defined, so more studies from daily clinical practice are needed. Although biologic therapy seems to be safe for patients with current cancer or a prior history of cancer, as has been demonstrated in other chronic inflammatory conditions, prospective studies in this specific population are needed. Until that time, it is crucial to manage such conditions via the combined clinical expertise of the gastroenterologist and oncologist.
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Affiliation(s)
- Viviana Laredo
- Department of Gastroenterology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
- School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Sandra García-Mateo
- Department of Gastroenterology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
- School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Samuel J. Martínez-Domínguez
- Department of Gastroenterology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
- School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Julia López de la Cruz
- Department of Gastroenterology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | - Carla J. Gargallo-Puyuelo
- Department of Gastroenterology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
- School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Fernando Gomollón
- Department of Gastroenterology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
- School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
- CIBER for Liver and Digestive Diseases (CIBERehd), 28029 Madrid, Spain
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Therapeutic Management of Adults with Inflammatory Bowel Disease and Malignancies: A Clinical Challenge. Cancers (Basel) 2023; 15:cancers15020542. [PMID: 36672491 PMCID: PMC9856548 DOI: 10.3390/cancers15020542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/11/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
Patients with chronic inflammatory bowel diseases (IBD) have increased risk of developing intestinal and extraintestinal cancers. However, once a diagnosis of malignancy is made, the therapeutic management of Crohn's disease (CD) and ulcerative colitis (UC) can be challenging as major guidelines suggest discontinuing the ongoing immunosuppressant and biological therapies for at least 2-5 years after the end of cancer treatment. Recently, new molecules such as vedolizumab and ustekinumab have been approved for IBD and limited data exist on the real risk of new or recurrent cancer in IBD patients with prior cancer, exposed to immunosuppressants and biologic agents. Thus, a multidisciplinary approach and case-by-case management is the preferred choice. The primary aim of our review was to summarize the current evidence about the safety of reintroducing an immunosuppressant or biologic agent in patients with a history of malignancy and to compare the different available therapies, including gut-selective agents. The secondary aim was to evaluate the clinical course of the IBD patients under cancer treatment who do not receive any specific immunosuppressant treatment after the diagnosis of cancer.
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Hong SJ, Zenger C, Pecoriello J, Pang A, Vallely M, Hudesman DP, Chang S, Axelrad JE. Ustekinumab and Vedolizumab Are Not Associated With Subsequent Cancer in IBD Patients with Prior Malignancy. Inflamm Bowel Dis 2022; 28:1826-1832. [PMID: 35262671 PMCID: PMC9713494 DOI: 10.1093/ibd/izac035] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is little data regarding the risk of new or recurrent cancer in patients with inflammatory bowel disease (IBD) and a prior history of cancer who are exposed to ustekinumab or vedolizumab. We assessed the risk of subsequent cancer in patients exposed to these agents. METHODS We performed a retrospective cohort study of patients with IBD and a history of cancer at an academic medical center between January 2013 and December 2020. We collected data on demographics, IBD and cancer disease characteristics, and drug exposures. The primary exposure was immunosuppressive therapy after diagnosis of cancer. The primary outcome was interval development of new or recurrent cancer. RESULTS Of 390 patients with IBD and a previous history of cancer, 37 were exposed to vedolizumab, 14 ustekinumab, 41 antitumor necrosis factor (anti-TNF), and 31 immunomodulator; and 267 were not exposed to immunosuppression following cancer diagnosis. During a total median follow-up time of 52 months, 81 (20%) patients developed subsequent cancer: 6 (16%) were exposed to vedolizumab, 2 (14%) to ustekinumab, 3 (10%) to immunomodulators, 12 (29%) to anti-TNF, and 56 (21%) with no immunosuppression (P = .41). In a multivariable Cox model adjusting for age, IBD subtype, smoking, cancer recurrence risk, and cancer stage, there was no increase in subsequent cancer with vedolizumab (adjusted hazard ratio, 1.36; 95% CI, 0.27-7.01) or ustekinumab (adjusted hazard ratio, 0.96; 95% CI, 0.17-5.41). Patients with more than 1 biologic exposure also did not have an increased risk of subsequent cancer. CONCLUSIONS Exposure to ustekinumab or vedolizumab in patients with IBD and a prior history of cancer does not appear to be associated with an increased risk of subsequent new or recurrent cancer.
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Affiliation(s)
- Simon J Hong
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - Cameron Zenger
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - Jillian Pecoriello
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - Alice Pang
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - Margaret Vallely
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - David P Hudesman
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - Shannon Chang
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
| | - Jordan E Axelrad
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology and Hepatology, New York, NY, USA
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Wu PJ, Sun CS, Kuo HT, Sheu MJ, Lin CY, Wang SH, Yang CC, Chen CH, Chuang SS, Feng IC. Iatrogenic Kaposi sarcoma of the small bowel in Crohn's disease following short-term use of immunomodulators: a case report and review of the literature. J Med Case Rep 2022; 16:424. [PMID: 36336687 PMCID: PMC9639291 DOI: 10.1186/s13256-022-03637-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Kaposi sarcoma is a vascular tumor highly related to human herpesvirus-8 and Kaposi sarcoma-associated herpesvirus. Kaposi sarcoma usually manifests as skin or mucosal lesions; involvement in visceral organs such as the gastrointestinal tract is rare. Kaposi sarcoma can occur in immunocompromised patients receiving immunosuppressive therapy, in which case it is known as iatrogenic Kaposi sarcoma or drug-induced Kaposi sarcoma. Intestinal Kaposi sarcoma in patients with inflammatory bowel disease is extremely rare. CASE PRESENTATION A 46-year-old East Asian male with recently diagnosed Crohn's disease was administered azathioprine and prednisolone; however, the patient complained of persistent abdominal pain and diarrhea following treatment. Endoscopy revealed small bowel Kaposi sarcoma. The patient was treated with systemic chemotherapy successfully without relapse. CONCLUSIONS This is the fifth case of Kaposi sarcoma developed over the small intestine in a patient with Crohn's disease following administration of immunomodulators. Additionally, this case indicated that even short-term immunomodulator use can induce Kaposi sarcoma in patients with inflammatory bowel disease. Thus, in patients with inflammatory bowel disease, if symptoms are aggravated or do not abate after immunomodulators prescription, and before intending to upgrade immunomodulators, endoscopy should be considered. Finally, chemotherapy can also be considered if both medication withdrawal and surgical intervention are not feasible.
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Affiliation(s)
- Pei-Jui Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, No.901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004, Taiwan, ROC
| | - Chi-Shu Sun
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, No.901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004, Taiwan, ROC
| | - Hsing-Tao Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, No.901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004, Taiwan, ROC
| | - Ming-Jen Sheu
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, No.901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004, Taiwan, ROC
| | - Cheng-Yi Lin
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, No.901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004, Taiwan, ROC
| | - Su-Hung Wang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, No.901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004, Taiwan, ROC
| | - Chun-Chi Yang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, No.901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004, Taiwan, ROC
| | - Chi-Hsing Chen
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, No.901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004, Taiwan, ROC
| | - Shih-Sung Chuang
- Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan, ROC
| | - I-Che Feng
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, No.901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004, Taiwan, ROC.
- College of Recreation and Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan, ROC.
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13
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Yamada M, Jinno H, Maeda Y, Sato A, Matsumoto A, Ikeda T, Sasajima Y. Management of Crohn’s disease relapse during neoadjuvant chemotherapy for bilateral breast cancer: a case report. Oxf Med Case Reports 2022; 2022:omac095. [PMID: 36176955 PMCID: PMC9514111 DOI: 10.1093/omcr/omac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/17/2022] [Accepted: 08/01/2022] [Indexed: 11/19/2022] Open
Abstract
Diagnosis of breast cancer in a patient with Crohn’s disease (CD) is uncommon. However, cytotoxic chemotherapy might help control CD during the treatment period. Here, we report a case of CD relapse during treatment with neoadjuvant chemotherapy (NAC) for bilateral breast cancer. A 39-year-old woman with CD controlled by infliximab and mesalazine was diagnosed with bilateral breast cancer. Infliximab treatment was discontinued temporarily so that the patient could receive NAC. However, her CD symptoms intensified during chemotherapy, and after her symptoms improved after a one-time administration of infliximab, the remainder of NAC was completed with a corticosteroid. Bilateral breast conservation surgery was performed. Histopathological examination revealed partial response of the left breast cancer and no residual cancer in the right breast. Breast irradiation and hormone therapy were added and no signs of recurrence have been observed for 5 years. CD has been well controlled with adalimumab and mesalazine.
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Affiliation(s)
- Miki Yamada
- Teikyo University School of Medicine Department of Surgery, , Tokyo, Japan
| | - Hiromitsu Jinno
- Teikyo University School of Medicine Department of Surgery, , Tokyo, Japan
| | - Yuka Maeda
- Teikyo University School of Medicine Department of Surgery, , Tokyo, Japan
| | - Ayana Sato
- Teikyo University School of Medicine Department of Surgery, , Tokyo, Japan
| | - Akiko Matsumoto
- Teikyo University School of Medicine Department of Surgery, , Tokyo, Japan
| | - Tatsuhiko Ikeda
- Teikyo University School of Medicine Department of Surgery, , Tokyo, Japan
| | - Yuko Sasajima
- Teikyo University School of Medicine Department of Pathology, , Tokyo, Japan
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Abstract
Inflammatory bowel diseases (IBD), including Crohn disease and ulcerative colitis, are chronic inflammatory conditions of the gastrointestinal tract. Individuals with IBD are at increased risk for several malignancies originating in the intestine, such as colorectal cancer, small bowel adenocarcinoma, intestinal lymphoma, and anal cancer. There are also several extraintestinal malignancies associated with IBD and IBD therapies, including cholangiocarcinoma, skin cancer, hematologic malignancies, genitourinary cancer, cervical cancer, and prostate cancer. The authors summarize the risk of cancer in patients with IBD, diagnosis and management of colorectal neoplasia in IBD, and management of patients with IBD and active or recent cancer.
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Affiliation(s)
- Adam S Faye
- Inflammatory Bowel Disease Center at NYU Langone Health, 305 East 33rd Street, Lower Level, New York, NY 10016, USA
| | - Ariela K Holmer
- Inflammatory Bowel Disease Center at NYU Langone Health, 305 East 33rd Street, Lower Level, New York, NY 10016, USA
| | - Jordan E Axelrad
- Inflammatory Bowel Disease Center at NYU Langone Health, 305 East 33rd Street, Lower Level, New York, NY 10016, USA.
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15
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Herrera-Gómez RG, Grecea M, Gallois C, Boige V, Pautier P, Pistilli B, Planchard D, Malka D, Ducreux M, Mir O. Safety and Efficacy of Bevacizumab in Cancer Patients with Inflammatory Bowel Disease. Cancers (Basel) 2022; 14:2914. [PMID: 35740579 PMCID: PMC9220809 DOI: 10.3390/cancers14122914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/29/2022] [Accepted: 06/09/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The safety of bevacizumab in combination with chemotherapy in patients with inflammatory bowel disease (IBD) and digestive and nondigestive cancers is poorly documented. METHODS We retrospectively evaluated patient records of all adult cancer patients with IBD at our institution from April 2007 to May 2016 with an update in November 2019. RESULTS Twenty-seven patients with a history of IBD (Crohn's disease, n = 22; ulcerative colitis, n = 5) who were treated with bevacizumab and chemotherapy for metastatic solid tumors were identified. At the time of advanced cancer diagnosis, 18 patients had quiescent IBD, whereas 9 patients had moderately active IBD. Among those with moderately active IBD, five had received corticosteroids less than six months prior to cancer diagnosis and one had received infliximab. The treated cancers were colorectal cancer (n = 13), small bowel cancer (n = 4), non-small cell lung cancer (n = 3), breast cancer (n = 3), and other cancers (n = 4). Patients received bevacizumab in combination with chemotherapy and/or as maintenance for a median of 6.7 months. Grade 2 or higher bevacizumab-related complications were proteinuria in two patients and hypertension, diarrhea, rectal bleeding, and intestinal perforation in one patient each. No clinical IBD flares were observed during bevacizumab treatment. CONCLUSION Bevacizumab combined with chemotherapy is safe in cancer patients with moderately active or quiescent IBD.
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Affiliation(s)
- Ruth Gabriela Herrera-Gómez
- Department of Cancer Medicine, Gustave Roussy Cancer Institute, 94805 Villejuif, France; (M.G.); (V.B.); (P.P.); (B.P.); (D.P.); (D.M.); (M.D.); (O.M.)
- Oncology Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Miruna Grecea
- Department of Cancer Medicine, Gustave Roussy Cancer Institute, 94805 Villejuif, France; (M.G.); (V.B.); (P.P.); (B.P.); (D.P.); (D.M.); (M.D.); (O.M.)
- Oncology Institute ‘Prof. Dr. I. Chiricuta’, 400015 Cluj-Napoca, Romania
| | - Claire Gallois
- Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris, 75015 Paris, France;
| | - Valérie Boige
- Department of Cancer Medicine, Gustave Roussy Cancer Institute, 94805 Villejuif, France; (M.G.); (V.B.); (P.P.); (B.P.); (D.P.); (D.M.); (M.D.); (O.M.)
| | - Patricia Pautier
- Department of Cancer Medicine, Gustave Roussy Cancer Institute, 94805 Villejuif, France; (M.G.); (V.B.); (P.P.); (B.P.); (D.P.); (D.M.); (M.D.); (O.M.)
| | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy Cancer Institute, 94805 Villejuif, France; (M.G.); (V.B.); (P.P.); (B.P.); (D.P.); (D.M.); (M.D.); (O.M.)
| | - David Planchard
- Department of Cancer Medicine, Gustave Roussy Cancer Institute, 94805 Villejuif, France; (M.G.); (V.B.); (P.P.); (B.P.); (D.P.); (D.M.); (M.D.); (O.M.)
| | - David Malka
- Department of Cancer Medicine, Gustave Roussy Cancer Institute, 94805 Villejuif, France; (M.G.); (V.B.); (P.P.); (B.P.); (D.P.); (D.M.); (M.D.); (O.M.)
| | - Michel Ducreux
- Department of Cancer Medicine, Gustave Roussy Cancer Institute, 94805 Villejuif, France; (M.G.); (V.B.); (P.P.); (B.P.); (D.P.); (D.M.); (M.D.); (O.M.)
| | - Olivier Mir
- Department of Cancer Medicine, Gustave Roussy Cancer Institute, 94805 Villejuif, France; (M.G.); (V.B.); (P.P.); (B.P.); (D.P.); (D.M.); (M.D.); (O.M.)
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16
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Minnis-Lyons SE, Aiken Z, Chow S, Din S. Managing IBD in patients with previous cancers. Frontline Gastroenterol 2022; 13:e44-e50. [PMID: 35812021 PMCID: PMC9234723 DOI: 10.1136/flgastro-2022-102187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/15/2022] [Indexed: 02/04/2023] Open
Abstract
A frequent dilemma faced in the inflammatory bowel disease (IBD) clinic is how to best treat a patient with a previous cancer diagnosis. The changing demographics of our patient population will make this quandary more common. Previous guidance has emphasised the importance of lengthy postcancer drug holidays and cautious use of IBD therapies. However, accumulating evidence suggests this approach may be unnecessarily conservative. This review considers recent evidence on the safety of IBD drugs, cancer and recurrent cancer risk in patients with IBD and provides a framework for shared decision making involving patient, gastroenterologist and oncologist.
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Affiliation(s)
| | - Zara Aiken
- Department of Medicine, St John's Hospital, NHS Lothian, Livingston, UK
| | - Shien Chow
- Department of Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK
| | - Shahida Din
- Gastroenterology Unit, NHS Lothian, Edinburgh, UK
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17
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Al-Arsan Al-Yaseen M, Haydar SA, Alali M, Saifo M. Gestational breast cancer in a patient with Crohn's disease: two case reports. J Med Case Rep 2021; 15:633. [PMID: 34961553 PMCID: PMC8711207 DOI: 10.1186/s13256-021-03224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background Diagnosis of breast cancer during gestation is a rare occurrence. In addition, the diagnosis of breast cancer in a patient with Crohn’s disease is not common. We present a rare case of gestational breast cancer in a patient with Crohn’s disease, with a concurrent breast cancer diagnosis in her sister. Case presentation A 31-year-old Syrian woman with Crohn’s disease was diagnosed with breast cancer at 30 weeks gestation; she received neoadjuvant chemotherapy during gestation. Incidentally, her 37-year-old sister was also diagnosed concomitantly with breast cancer. Both sisters underwent and successfully completed surgery and adjuvant therapy. At a 5-year review, both patients showed no signs of recurrence. The Crohn’s disease symptoms have also improved after chemotherapy, and the baby born after gestational chemotherapy is currently 5 years old with normal psychomotor development and without any congenital malformations. Conclusions This case report highlights the impact of gestation on breast cancer outcomes, the possibility of giving chemotherapy during gestation, and the effect of chemotherapy on the symptoms of Crohn’s disease. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-021-03224-3.
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Affiliation(s)
| | - Salah Aldin Haydar
- Faculty of Medicine, Damascus University, Fayez Mansour Street, P. O. Box: 222, Damascus, Syria
| | - Mousa Alali
- Department of Oncology, Al-Bairouni University Hospital, Damascus University, Harasta M5, Damascus, Syria
| | - Maher Saifo
- Faculty of Medicine, Damascus University, Fayez Mansour Street, P. O. Box: 222, Damascus, Syria. .,Department of Oncology, Al-Bairouni University Hospital, Damascus University, Harasta M5, Damascus, Syria. .,Faculty of Pharmacy, Alsham Private University, Damascus, Syria.
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18
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Qu B, Cao T, Wang M, Wang S, Li W, Li H. Ginsenosides Rd monomer inhibits proinflammatory cytokines production and alleviates DSS-colitis by NF-κB and P38MAPK pathways in mice. Immunopharmacol Immunotoxicol 2021; 44:110-118. [PMID: 34898349 DOI: 10.1080/08923973.2021.2012482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ulcerative colitis (UC) is dramatically increasing worldwide, cannot be thoroughly cured, and reduces patients' quality of life. Excessive activation of macrophages and over-production of cytokines play an important role in the pathogenesis of UC. Therefore, for its treatment, inhibiting macrophages' hyperactivation would be effective to develop new treatment approaches. Ginsenosides, extracted from ginseng, show an anti-inflammatory effect on the immunologic process. Our study used ginsenosides Rd monomer (GRd) to intervene in DSS-induced colitis mouse models and tested the immunological effect of macrophages. METHOD We observed body weights, weights of colons, colonic lengths, and inflammatory scores, as well as histological changes of DSS/DSS-GRd mice. We also isolated intestinal and peritoneal macrophages, performed qRT-PCR and ELISA to detect cytokines production by macrophages, and screened possible involved pathways by Western blotting. RESULTS Administering 20 mg/Kg GRd to DSS mice for 7-14 days reduced colonic inflammation. Moreover, both in vivo and in vitro, levels of TNF-α, IFN-γ, IL-6, IL-12/23p40, and IL-17A were all inhibited by GRd at 14 days in intestinal macrophages, and 20 μmol/L GRd at 12 h in peritoneal macrophages, respectively, but longer time made no more benefit. Western blotting showed GRd could decrease expression of pJNK, p-p38, pIκBα, and P65 in nuclear. CONCLUSIONS Our data indicate that GRd could down-regulate cytokines production in macrophages and alleviate DSS-colitis in mice, which may be related to NF-κB and P38MAPK pathways. These results suggest that GRd has an anti-inflammatory effect on experimental colitis and may have potential efficacy in the treatment of UC alone or in combination.
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Affiliation(s)
- Bo Qu
- Digestive Department, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ting Cao
- Digestive Department, The 3rd Affiliated Hospital of Qiqihar Medical College, Qiqihar, China
| | - Miao Wang
- Digestive Department, Yiwu Central Hospital, Yiwu, China
| | - Shuang Wang
- Digestive Department, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wanying Li
- Digestive Department, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui Li
- Digestive Department, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
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19
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Duan L, Cheng S, Li L, Liu Y, Wang D, Liu G. Natural Anti-Inflammatory Compounds as Drug Candidates for Inflammatory Bowel Disease. Front Pharmacol 2021; 12:684486. [PMID: 34335253 PMCID: PMC8316996 DOI: 10.3389/fphar.2021.684486] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/02/2021] [Indexed: 12/11/2022] Open
Abstract
Inflammatory bowel disease (IBD) represents chronic recurrent intestinal inflammation resulting from various factors. Crohn’s disease (CD) and ulcerative colitis (UC) have been identified as the two major types of IBD. Currently, most of the drugs for IBD used commonly in the clinic have adverse reactions, and only a few drugs present long-lasting treatment effects. Moreover, issues of drug resistance and disease recurrence are frequent and difficult to resolve. Together, these issues cause difficulties in treating patients with IBD. Therefore, the development of novel therapeutic agents for the prevention and treatment of IBD is of significance. In this context, research on natural compounds exhibiting anti-inflammatory activity could be a novel approach to developing effective therapeutic strategies for IBD. Phytochemicals such as astragalus polysaccharide (APS), quercetin, limonin, ginsenoside Rd, luteolin, kaempferol, and icariin are reported to be effective in IBD treatment. In brief, natural compounds with anti-inflammatory activities are considered important candidate drugs for IBD treatment. The present review discusses the potential of certain natural compounds and their synthetic derivatives in the prevention and treatment of IBD.
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Affiliation(s)
- Linshan Duan
- School of Pharmaceutical Sciences Xiamen University, Xiamen, China
| | - Shuyu Cheng
- Institute of Gastrointestinal Oncology, Medical College of Xiamen University, Xiamen, China
| | - Long Li
- Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, China
| | - Yanling Liu
- School of Pharmaceutical Sciences Xiamen University, Xiamen, China
| | - Dan Wang
- Institute of Gastrointestinal Oncology, Medical College of Xiamen University, Xiamen, China
| | - Guoyan Liu
- School of Pharmaceutical Sciences Xiamen University, Xiamen, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, Xiamen, China.,Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, China
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20
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Flores E, Mbachi C, Achebe I, Asotibe J, Palomera-Tejeda E, Vohra I, Udechukwu V, Kotwal V. Temporal trend in inpatient mortality in inflammatory bowel disease-associated colorectal cancer vs non-inflammatory colorectal cancer: a nationwide retrospective study. Int J Colorectal Dis 2021; 36:701-708. [PMID: 33063223 DOI: 10.1007/s00384-020-03775-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early detection and advancement in therapy have successfully achieved a steady decrease in colorectal cancer (CRC) mortality over the last two decades. On the other hand, studies investigating mortality trends in inflammatory bowel disease-associated CRC (IBD-CRC) are scarce and inconclusive. We conducted a retrospective analysis aiming to identify differences between inpatient mortality trends in IBD-CRC vs non-IBD-CRC and possible contributing factors. METHODS The National Inpatient Sample (NIS) database from 2006-2014 was queried to identify all patients admitted with a diagnosis of CRC. The main outcome was the prevalence and trend of mortality among IBD-CRC and non-IBD-CRC. The secondary outcome was the evaluation of predictors of inpatient mortality. RESULTS A total of 1,190,759 weighted cases with the admission diagnosis of CRC were included in the study. Of which 10,997 (0.9%) had a co-diagnosis of IBD. The population with non-IBD-CRC had a statistically significant downward temporal trend in mortality (p < 0.001), while patients with IBD-CRC did not have any statistically significant temporal trend in inpatient mortality (p = 0.067). After subgroup analysis, patients with Crohn's disease-CRC had an upward temporal trend in mortality (p = 0.183) compared to patients with ulcerative colitis-CRC with a downward trend in mortality (p = 0.001). Sepsis resulted to be a stronger predictor of mortality for CD-CRC, while VTE for UC-CRC. CONCLUSION Multiples strategies established to prevent morbidity and mortality in CRC have been fruitful in non-IBD-CRC population, but have not been enough for IBD-CRC population to cause the same effect. Further strategies are needed to achieve a reduction in IBD-CRC mortality trend.
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Affiliation(s)
- Estefania Flores
- Department of Medicine, Cook County Health and Hospitals System, Chicago, IL, USA.
| | - Chimezie Mbachi
- Gastroenterology and Hepatology, Yale School of Medicine, New Haven, CT, USA
| | - Ikechukwu Achebe
- Department of Medicine, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Jennifer Asotibe
- Department of Medicine, Cook County Health and Hospitals System, Chicago, IL, USA
| | | | - Ishaan Vohra
- Department of Medicine, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Victor Udechukwu
- Department of Medicine, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Vikram Kotwal
- Division of Gastroenterology and Hepatology, Cook County Health and Hospitals System, County, Chicago, IL, USA
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21
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Challenges in Crohn's Disease Management after Gastrointestinal Cancer Diagnosis. Cancers (Basel) 2021; 13:cancers13030574. [PMID: 33540674 PMCID: PMC7867285 DOI: 10.3390/cancers13030574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Crohn’s disease (CD) is a chronic inflammatory bowel disease affecting both young and elderly patients, involving the entire gastrointestinal tract from the mouth to anus. The chronic transmural inflammation can lead to several complications, among which gastrointestinal cancers represent one of the most life-threatening, with a higher risk of onset as compared to the general population. Moreover, diagnostic and therapeutic strategies in this subset of patients still represent a significant challenge for physicians. Thus, the aim of this review is to provide a comprehensive overview of the current evidence for an adequate diagnostic pathway and medical and surgical management of CD patients after gastrointestinal cancer onset. Abstract Crohn’s disease (CD) is a chronic inflammatory bowel disease with a progressive course, potentially affecting the entire gastrointestinal tract from mouth to anus. Several studies have shown an increased risk of both intestinal and extra-intestinal cancer in patients with CD, due to long-standing transmural inflammation and damage accumulation. The similarity of symptoms among CD, its related complications and the de novo onset of gastrointestinal cancer raises difficulties in the differential diagnosis. In addition, once a cancer diagnosis in CD patients is made, selecting the appropriate treatment can be particularly challenging. Indeed, both surgical and oncological treatments are not always the same as that of the general population, due to the inflammatory context of the gastrointestinal tract and the potential exacerbation of gastrointestinal symptoms of patients with CD; moreover, the overlap of the neoplastic disease could lead to adjustments in the pharmacological treatment of the underlying CD, especially with regard to immunosuppressive drugs. For these reasons, a case-by-case analysis in a multidisciplinary approach is often appropriate for the best diagnostic and therapeutic evaluation of patients with CD after gastrointestinal cancer onset.
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22
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Abstract
IMPORTANCE Crohn disease, a chronic gastrointestinal inflammatory disease, is increasing in incidence and prevalence in many parts of the world. Uncontrolled inflammation leads to long-term complications, including fibrotic strictures, enteric fistulae, and intestinal neoplasia. Therefore, early and effective control of inflammation is of critical importance. OBSERVATIONS The optimal management approach for Crohn disease incorporates patient risk stratification, patient preference, and clinical factors in therapeutic decision-making. First-line therapy generally consists of steroids for rapid palliation of symptoms during initiation of anti-tumor necrosis factor α therapy. Other treatments may include monoclonal antibodies to IL-12/23 or integrin α4β7, immunomodulators, combination therapies, or surgery. Effective control of inflammation reduces the risk of penetrating complications (such as intra-abdominal abscesses and fistulae), although more than half of patients will develop complications that require surgery. Adverse reactions to therapy include antibody formation and infusion reactions, infections, and cancers associated with immune modulators and biologics and toxicity to the bone marrow and the liver. Both Crohn disease and corticosteroid use are associated with osteoporosis. Vaccinations to prevent infections, such as influenza, pneumonia, and herpes zoster, are important components of health maintenance for patients with Crohn disease, although live vaccines are contraindicated for patients receiving immune suppression therapy. CONCLUSIONS AND RELEVANCE The treatment of patients with Crohn disease depends on disease severity, patient risk stratification, patient preference, and clinical factors, including age of onset and penetrating complications, and includes treatment with steroids, monoclonal antibody therapies, immunomodulators, and surgery. Physicians should be familiar with the advantages and disadvantages of each therapy to best counsel their patients.
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Affiliation(s)
- Kelly Cushing
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Peter D R Higgins
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor
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23
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Risk of colorectal cancer in inflammatory bowel diseases. Semin Cancer Biol 2020; 64:51-60. [DOI: 10.1016/j.semcancer.2019.05.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 12/21/2022]
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24
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Oh GM, Moon W. Tumor necrosis factor-α inhibitor use in patients with malignancy: is it safe? Intest Res 2020; 18:245-246. [PMID: 32713169 PMCID: PMC7385576 DOI: 10.5217/ir.2020.00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/10/2022] Open
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25
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Axelrad JE, Bazarbashi A, Zhou J, Castañeda D, Gujral A, Sperling D, Glass J, Agrawal M, Hong S, Lawlor G, Hudesman D, Chang S, Shah S, Yajnik V, Ananthakrishnan A, Khalili H, Colombel JF, Itzkowitz S. Hormone Therapy for Cancer Is a Risk Factor for Relapse of Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2020; 18:872-880.e1. [PMID: 31302306 PMCID: PMC7354097 DOI: 10.1016/j.cgh.2019.06.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/03/2019] [Accepted: 06/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Exposure to hormone contraception has been associated with an increased risk of relapse of inflammatory bowel diseases (IBDs). Little is known about the effects of cancer therapies, specifically hormone therapies, on the course of IBD. METHODS We conducted a retrospective cohort study, collecting data from 5 medical centers, on patients with IBD who received a subsequent diagnosis of breast or prostate cancer from 1997 through 2018. For patients with quiescent IBD at their cancer diagnosis, the primary outcome was relapse of IBD. For patients with active IBD at their cancer diagnosis, the primary outcome was IBD remission. RESULTS Our analysis included 447 patients with IBD (44% with Crohn's disease, 53% with ulcerative colitis, and 3% with IBD unclassified) who had either breast (78%) or prostate (22%) cancer. At their cancer diagnosis, 400 patients (90%) had inactive IBD, and 47 (10%) had active IBD. Among patients with inactive IBD, 112 (28%) developed active IBD. Previous exposure to steroids, immunomodulators, or biologics was associated with IBD relapse after a cancer diagnosis (hazard ratio [HR] for steroids, 1.79; 95% CI, 1.18-2.71; HR for immunomodulators, 2.22; 95% CI, 1.38-3.55; HR for biologics, 1.95; 95% CI, 1.01-5.36). Hormone monotherapy (HR, 2.00; 95% CI, 1.21-3.29) and combination cytotoxic and hormone therapy (HR, 1.86; 95% CI, 1.01-3.43) was associated with IBD relapse. Among 34 patients who received only cytotoxic chemotherapy, 75% remained in remission from IBD at 250 months compared with 42% of those who received hormone monotherapy (log rank, 0.02). Among patients with active IBD at their cancer diagnosis, 14 (30%) entered remission from IBD, but there were no significant factors of achieving IBD remission. CONCLUSIONS In a multicenter retrospective study, we found that patients with IBD and breast or prostate cancer who receive hormone therapy have an increased risk for relapse of IBD and related adverse outcomes.
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Affiliation(s)
- Jordan E Axelrad
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, New York.
| | - Ahmad Bazarbashi
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts
| | - James Zhou
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Daniel Castañeda
- Division of Gastroenterology and Hepatology, Department of Medicine, Cleveland Clinic Florida, Weston, Florida
| | - Amandeep Gujral
- Crohn's and Colitis Center at Massachusetts General Hospital, Division of Gastroenterology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Dylan Sperling
- Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jason Glass
- Division of Gastroenterology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Manasi Agrawal
- Division of Gastroenterology, Department of Medicine, Lenox Hill Hospital, New York, New York
| | - Simon Hong
- Division of Gastroenterology, Department of Medicine, Montefiore Medical Center, New York, New York
| | - Garrett Lawlor
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, New York, New York
| | - David Hudesman
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Shannon Chang
- Inflammatory Bowel Disease Center at New York University Langone Health, Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Shailja Shah
- Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vijay Yajnik
- Crohn's and Colitis Center at Massachusetts General Hospital, Division of Gastroenterology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ashwin Ananthakrishnan
- Crohn's and Colitis Center at Massachusetts General Hospital, Division of Gastroenterology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Hamed Khalili
- Crohn's and Colitis Center at Massachusetts General Hospital, Division of Gastroenterology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven Itzkowitz
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract
PURPOSE OF REVIEW Both the chronic inflammation in inflammatory bowel disease (IBD), and its treatment, can increase the risk of malignancy. There is also an increasing number of patients with current and prior cancer who require IBD treatment. Thus, there is a complex interplay between immunosuppressive treatment and monitoring for new and recurrent cancer. RECENT FINDINGS Vedolizumab and ustekinumab have not been shown to increase the risk of malignancy. Transplant data shows a potential risk with tofacitinib although rheumatoid arthritis data does not. IBD patients have been shown to tolerate chemotherapy, specifically with cytotoxic compared with hormonal chemotherapy. Patients with prior cancer are at increased risk of new or recurrent cancers; however, immunosuppression appears to be safe. Emerging treatments for IBD have demonstrated acceptable safety profiles for malignancy risk, and immunosuppression appears to be safe for use in patients with current and prior malignancy. More data is still needed to assess long-term risk of malignancy in these patients, especially with newer treatments.
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Affiliation(s)
- Jessica Kimmel
- Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
| | - Jordan Axelrad
- Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center at New York University Langone Health, New York University School of Medicine, New York, NY, USA
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Lin SC, Goldowsky A, Papamichael K, Cheifetz AS. The Treatment of Inflammatory Bowel Disease in Patients With a History of Malignancy. Inflamm Bowel Dis 2019; 25:998-1005. [PMID: 30590558 PMCID: PMC7534371 DOI: 10.1093/ibd/izy376] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 12/13/2022]
Abstract
As patients with inflammatory bowel disease (IBD) are living longer and our medical armamentarium expands, gastroenterologists are more frequently faced with treatment decisions about patients with IBD who also have a history of malignancy. This review aims to summarize the current literature on IBD, the inherent risk of developing gastrointestinal and extra-intestinal malignancies, and the risk of malignancies associated with available biologic and immunomodulatory therapies and to discuss the overall treatment strategy for a patient with a history of malignancy.
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Affiliation(s)
- Steven C Lin
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Alex Goldowsky
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Konstantinos Papamichael
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Adam S Cheifetz
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts,Address correspondence to: Adam S. Cheifetz, MD, Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 ()
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Sebastian S, Neilaj S. Practical guidance for the management of inflammatory bowel disease in patients with cancer. Which treatment? Therap Adv Gastroenterol 2019; 12:1756284818817293. [PMID: 30643542 PMCID: PMC6322094 DOI: 10.1177/1756284818817293] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Clinicians involved in the treatment of inflammatory bowel disease (IBD) increasingly come across patients with current or previous history of malignancies. With increasing and earlier use of immunosuppression and biologics in IBD patients, the question arises whether these treatments further increase the risk of new or recurrent cancers. A number of population-based observational studies have now reported the odds of development of new or recurrent cancers with thiopurines and antitumour necrosis factors (anti-TNFs). These data combined with data arising from treatment registries from other immune disorders such as rheumatoid arthritis are providing evidence of relative risks and safety profiles of these agents in the setting of active or prior cancer. Data from transplant literature give an indication for providing a drug-holiday period in patients with treated cancers. The risks of the treatment should be considered alongside the risk associated with withholding these effective treatments in patients with active IBD. In this review, we aim to summarize the current evidence in this area and provide a practical guidance.
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Affiliation(s)
- Shaji Sebastian
- Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Hull HU3 2JZ, UK
| | - Steven Neilaj
- IBD Unit, Department of Gastroenterology Hull York Medical School,Faculty of health Science, University of Hull and York, Hull, UK
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29
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Shah SC, Khalili H, Gower-Rousseau C, Olen O, Benchimol EI, Lynge E, Nielsen KR, Brassard P, Vutcovici M, Bitton A, Bernstein CN, Leddin D, Tamim H, Stefansson T, Loftus EV, Moum B, Tang W, Ng SC, Gearry R, Sincic B, Bell S, Sands BE, Lakatos PL, Végh Z, Ott C, Kaplan GG, Burisch J, Colombel JF. Sex-Based Differences in Incidence of Inflammatory Bowel Diseases-Pooled Analysis of Population-Based Studies From Western Countries. Gastroenterology 2018; 155:1079-1089.e3. [PMID: 29958857 DOI: 10.1053/j.gastro.2018.06.043] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Although the incidence of inflammatory bowel diseases (IBDs) varies with age, few studies have examined variations between the sexes. We therefore used population data from established cohorts to analyze sex differences in IBD incidence according to age at diagnosis. METHODS We identified population-based cohorts of patients with IBD for which incidence and age data were available (17 distinct cohorts from 16 regions of Europe, North America, Australia, and New Zealand). We collected data through December 2016 on 95,605 incident cases of Crohn's disease (CD) (42,831 male and 52,774 female) and 112,004 incident cases of ulcerative colitis (UC) (61,672 male and 50,332 female). We pooled incidence rate ratios of CD and UC for the combined cohort and compared differences according to sex using random effects meta-analysis. RESULTS Female patients had a lower risk of CD during childhood, until the age range of 10-14 years (incidence rate ratio, 0.70; 95% CI, 0.53-0.93), but they had a higher risk of CD thereafter, which was statistically significant for the age groups of 25-29 years and older than 35 years. The incidence of UC did not differ significantly for female vs male patients (except for the age group of 5-9 years) until age 45 years; thereafter, men had a significantly higher incidence of ulcerative colitis than women. CONCLUSIONS In a pooled analysis of population-based studies, we found age at IBD onset to vary with sex. Further studies are needed to investigate mechanisms of sex differences in IBD incidence.
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Affiliation(s)
- Shailja C Shah
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Corinne Gower-Rousseau
- Public Health Unit, Epimad Registre, Lille University Hospital, France; INSERM LIRIC, UMR 995, Lille University, France
| | - Ola Olen
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eric I Benchimol
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Elsebeth Lynge
- Division of Gastroenterology, University of Copenhagen, Copenhagen, Denmark
| | - Kári R Nielsen
- Division of Gastroenterology, National Hospital, Tórshavn, Faroe Islands
| | - Paul Brassard
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Maria Vutcovici
- Department of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | - Alain Bitton
- Department of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | - Charles N Bernstein
- Division of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Desmond Leddin
- Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hala Tamim
- Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tryggvi Stefansson
- Division of Gastroenterology, National University Hospital of Iceland, Reykjavík, Iceland
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, New York
| | - Bjørn Moum
- Department of Gastroenterology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Whitney Tang
- Department of Medicine and Therapeutics, Institute of Digestive Disease, LKS Institute of Health Science, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, LKS Institute of Health Science, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Richard Gearry
- Division of Gastroenterology, University of Otago, Christchurch, New Zealand
| | - Brankica Sincic
- Division of Gastroenterology, University of Rijeka, Rijeka, Croatia
| | - Sally Bell
- Division of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia
| | - Bruce E Sands
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York
| | - Peter L Lakatos
- Division of Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Végh
- Division of Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Claudia Ott
- Division of Gastroenterology, University of Regensburg, Regensburg, Germany
| | - Gilaad G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
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Koc ÖM, van Kampen RJW, van Bodegraven AA. Cancer-Associated Chemotherapy Induces Less IBD Exacerbations and a Reduction of IBD Medication Afterwards. Inflamm Bowel Dis 2018; 24:1606-1611. [PMID: 29669052 DOI: 10.1093/ibd/izy053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prevalence of inflammatory bowel disease (IBD) is increasing and, consequently, more IBD patients will develop cancer with need for cancer-associated chemotherapy. Physicians are therefore confronted with whether they should continue, stop, or restart IBD medication in relation with chemotherapy. The current strategy in our hospital is to discontinue immunomodulating IBD medication, comprising corticosteroids, anti-tumour necrosis factor (anti-TNF), and other immunosuppressives, before starting chemotherapy. METHODS Out of 1826 patients with IBD, we analyzed 41 IBD patients who received chemotherapy between January 2006-2017. The primary endpoint was the effect of chemotherapy on IBD course, assessed by number of exacerbations and use of IBD medication. The paired-samples t-test and Wilcoxon Signed-Rank test were performed. RESULTS The mean number of IBD exacerbations of 0.3 (0.0-0.6) per 5 years after chemotherapy was lower compared to 1.4 (0.8-1.9) exacerbations per 5 years before chemotherapy exposure (P < 0.01). In terms of IBD medication, there was a decrease in the number of patients using mesalazine (47% vs 71%, P < 0.01) or corticosteroids (9% vs 32%, P = 0.02) in a time span of 5 years after compared to 5 years before chemotherapy. There was also a trend of less use of immunosuppressives (anti-TNF 0% vs 15%, P = 0.25; thiopurines 12% vs 34%, P = 0.13). CONCLUSIONS Cancer-associated chemotherapy is associated with a more benign course of IBD that may contribute to the decision to discontinue anti-TNF or other immunosuppressives in relation to cancer-associated treatment both before the start of chemotherapy, as well as reinitiating aggressive immunosuppressives for IBD afterwards.
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Affiliation(s)
- Özgür M Koc
- Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Gastroenterology and Hepatology, Zuyderland Medical Centre, Sittard-Geleen-Heerlen, the Netherlands
| | - Roel J W van Kampen
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard-Geleen-Heerlen, the Netherlands
| | - Adriaan A van Bodegraven
- Department of Gastroenterology and Hepatology, Zuyderland Medical Centre, Sittard-Geleen-Heerlen, the Netherlands
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31
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Fujita K, Mizumoto Y, Moriyoshi K, Araki N, Mio T. Acute onset of ulcerative colitis during chemoradiotherapy for anaplastic lymphoma kinase-positive lung adenocarcinoma. Respirol Case Rep 2017; 6:e00288. [PMID: 29321932 PMCID: PMC5756712 DOI: 10.1002/rcr2.288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/08/2017] [Accepted: 11/18/2017] [Indexed: 11/23/2022] Open
Abstract
We report a case of acute onset of ulcerative colitis (UC) during chemoradiotherapy in a patient with anaplastic lymphoma kinase (ALK)‐positive lung adenocarcinoma. A 46‐year‐old male patient with an abnormal chest shadow was referred to our hospital. He was diagnosed with lung adenocarcinoma, clinical stage T1aN3M0 and stage IIIB. Concurrent chemoradiotherapy was selected for his initial therapy. After two cycles of cisplatin and vinorelbine administration, he experienced persistent diarrhoea and anorexia. Findings of the colonoscopy revealed a pancolitis type of UC. After discontinuation of chemotherapy, oral administration of mesalazine was initiated. The development of UC during chemotherapy is very rare and only a few case reports have been published. Although adverse events are rare, it is very important to assess the colitis precisely by performing a colonoscopy when protracted abdominal pain is experienced by the patient, along with diarrhoea or bloody stool during chemotherapy.
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Affiliation(s)
- Kohei Fujita
- Division of Respiratory Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Yoshinori Mizumoto
- Division of Gastroenterology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Koki Moriyoshi
- Division of Clinical Pathology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Norio Araki
- Division of Radiation Oncology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Tadashi Mio
- Division of Respiratory Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
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32
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Axelrad J, Kriplani A, Ozbek U, Harpaz N, Colombel JF, Itzkowitz S, Holcombe RF, Ang C. Chemotherapy Tolerance and Oncologic Outcomes in Patients With Colorectal Cancer With and Without Inflammatory Bowel Disease. Clin Colorectal Cancer 2016; 16:e205-e210. [PMID: 27742264 DOI: 10.1016/j.clcc.2016.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/08/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD), comprising Crohn disease and ulcerative colitis, is a risk factor for colorectal cancer (CRC). Chemotherapy toxicity may exacerbate IBD symptoms and vice versa, but data are limited. We evaluated chemotherapy tolerance and oncologic outcomes in patients with CRC with and without IBD. PATIENTS AND METHODS Medical records of patients with CRC with and without IBD treated between 2008 and 2013 were reviewed. Where possible, patients were matched by age, sex, stage, and diagnosis year. Chemotherapy tolerance and survival outcomes were compared between patients with IBD and without IBD. RESULTS A total of 158 subjects with CRC were included: 80 patients had IBD and 78 matched control patients did not have IBD. Between cases and controls, there were no significant differences in demographic data, stage of CRC, and cancer treatments, with equivalent numbers of patients receiving surgery, radiation, and chemotherapy. Patients with IBD experienced more CRC treatment alterations than those without IBD (74% vs. 44%, P = .03), largely due to a higher frequency of treatment delays among patients with IBD. Differences in stage-specific 5-year overall survival (OS) and recurrence-free survival (RFS) in patients with and without IBD were not significant, except for stage IV patients with IBD who had significantly shorter OS than those without IBD. Patients with histologically active IBD did not require more chemotherapy alterations than patients with inactive IBD. CONCLUSION In this series, patients with CRC with IBD experienced more treatment alterations (mostly delays) than those without IBD. Patients with stage IV CRC with IBD had shorter survival than patients without IBD.
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Affiliation(s)
- Jordan Axelrad
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, New York, NY.
| | - Anuja Kriplani
- Division of Hematology and Oncology, Department of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Umut Ozbek
- Population Health Science and Policy, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Noam Harpaz
- Division of Hematology and Oncology, Department of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY; Department of Pathology, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Department of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven Itzkowitz
- Division of Gastroenterology, Department of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Randall F Holcombe
- Division of Hematology and Oncology, Department of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Celina Ang
- Division of Hematology and Oncology, Department of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY
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Shelton E, Laharie D, Scott FI, Mamtani R, Lewis JD, Colombel JF, Ananthakrishnan AN. Cancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis. Gastroenterology 2016; 151:97-109.e4. [PMID: 27039969 PMCID: PMC4925196 DOI: 10.1053/j.gastro.2016.03.037] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/20/2016] [Accepted: 03/23/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Physicians frequently encounter patients with immune-mediated diseases and a history of malignancy. There are limited data on the safety of immunosuppressive therapy for these patients. Published studies have been small with few events, precluding robust estimates of risk. METHODS We searched Medline, EMBASE, and conference proceedings for terms related to immune-mediated disease, immune-suppressive therapy, and cancer recurrence from inception to April 2015. We included 16 studies (9 of patients with rheumatoid arthritis, 8 of patients with inflammatory bowel disease, and 1 of patients with psoriasis) and stratified studies by type of immune-suppressive therapy (monoclonal antibodies to tumor necrosis factor [anti-TNF], conventional immune-modulatory agents, or no immune suppression). A random-effects meta-analysis was performed to calculate the pooled incidence rates as well as risk differences between the various treatments. RESULTS Our analysis included 11,702 persons contributing 31,258 person-years (p-y) of follow-up evaluation after a prior diagnosis of cancer. Rates of cancer recurrence were similar among individuals receiving anti-TNF therapy (33.8 per 1000 p-y), immune-modulator therapy (36.2 per 1000 p-y), or no immunosuppression (37.5 per 1000 p-y), but were numerically higher among patients receiving combination immune suppression (54.5 per 1000 p-y) (P > .1 for all). Subgroup analysis of new and recurrent cancers separately, type of immune-modulator therapy, or immune-mediated disease showed similar results, with no increase in risk. We found similar pooled incidence values for new or primary cancers when immunosuppression was initiated within 6 years (33.6 per 1000 p-y for immune-modulatory agents and 43.7 per 1000 p-y for anti-TNF agents) vs more than 6 years after the index cancer (32.9 per 1000 p-y for immune-modulatory agents, P = .86; and 21.0 per 1000 p-y for anti-TNF agents, P = .43). CONCLUSIONS In a meta-analysis of 16 studies, we observed similar rates of cancer recurrence among individuals with prior cancer who received no immunosuppression, anti-TNF therapy, immune-modulator therapy, or combination treatments. Prospective studies are needed to ascertain optimal intervals for re-initiation of immune-suppressive therapies for individuals with specific cancers.
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Affiliation(s)
- Edward Shelton
- Gastroenterology Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - David Laharie
- Service d'Hépato-Gastroentérologie, University Bordeaux, Laboratoire de Bactériologie, Bordeaux, Pessac, France
| | - Frank I Scott
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ronac Mamtani
- Division of Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James D Lewis
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ashwin N Ananthakrishnan
- Gastroenterology Unit, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Axelrad JE, Lichtiger S, Yajnik V. Inflammatory bowel disease and cancer: The role of inflammation, immunosuppression, and cancer treatment. World J Gastroenterol 2016; 22:4794-4801. [PMID: 27239106 PMCID: PMC4873872 DOI: 10.3748/wjg.v22.i20.4794] [Citation(s) in RCA: 312] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 03/25/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
In patients with inflammatory bowel disease (IBD), chronic inflammation is a major risk factor for the development of gastrointestinal malignancies. The pathogenesis of colitis-associated cancer is distinct from sporadic colorectal carcinoma and the critical molecular mechanisms underlying this process have yet to be elucidated. Patients with IBD have also been shown to be at increased risk of developing extra-intestinal malignancies. Medical therapies that diminish the mucosal inflammatory response represent the foundation of treatment in IBD, and recent evidence supports their introduction earlier in the disease course. However, therapies that alter the immune system, often used for long durations, may also promote carcinogenesis. As the population of patients with IBD grows older, with longer duration of chronic inflammation and longer exposure to immunosuppression, there is an increasing risk of cancer development. Many of these patients will require cancer treatment, including chemotherapy, radiation, hormonal therapy, and surgery. Many patients will require further treatment for their IBD. This review seeks to explore the characteristics and risks of cancer in patients with IBD, and to evaluate the limited data on patients with IBD and cancer, including management of IBD after a diagnosis of cancer, the effects of cancer treatment on IBD, and the effect of IBD and medications for IBD on cancer outcomes.
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35
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Jauregui-Amezaga A, Vermeire S, Prenen H. Use of biologics and chemotherapy in patients with inflammatory bowel diseases and cancer. Ann Gastroenterol 2016; 29:127-36. [PMID: 27065724 PMCID: PMC4805731 DOI: 10.20524/aog.2016.0004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients with inflammatory bowel disease have an additional risk of developing cancer compared with the general population. This is due to local chronic inflammation that leads to the development of gastrointestinal cancers and the use of thiopurines, associated with a higher risk of lymphoproliferative disorders, skin cancers, or uterine cervical cancers. Similar to the general population, a previous history of cancer in inflammatory bowel disease patients increases the risk of developing a secondary cancer. Large studies have not shown an increased risk of cancer in patients treated with biologics. In this review we discuss the prevention and treatment of cancer in patients with inflammatory bowel disease.
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Affiliation(s)
| | | | - Hans Prenen
- Department of Gastroenterology, University Hospital Leuven, Belgium
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36
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Axelrad J, Bernheim O, Colombel JF, Malerba S, Ananthakrishnan A, Yajnik V, Hoffman G, Agrawal M, Lukin D, Desai A, McEachern E, Bosworth B, Scherl E, Reyes A, Zaidi H, Mudireddy P, DiCaprio D, Sultan K, Korelitz B, Wang E, Williams R, Chen L, Katz S, Itzkowitz S. Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents. Clin Gastroenterol Hepatol 2016; 14:58-64. [PMID: 26247164 DOI: 10.1016/j.cgh.2015.07.037] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 07/22/2015] [Accepted: 07/24/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Our understanding of malignancy associated with immunosuppression in patients with inflammatory bowel disease (IBD) comes from studies of individuals with no history of cancer. We investigated whether patients with IBD and a history of cancer who were subsequently immunosuppressed have an increased risk of developing incident cancer. METHODS We performed a retrospective analysis of data from 333 patients with IBD treated at 8 academic medical centers who developed cancer and subsequently received treatment with anti-tumor necrosis factor (TNF), anti-TNF with an antimetabolite (thiopurines, methotrexate), antimetabolites, or no subsequent exposure to immunosuppressive agents (controls). We collected data on their primary outcomes of incident cancers (new or recurrent). Hazard ratios (HRs) were calculated by using Cox proportional hazards and Kaplan-Meier survival curves; study groups were compared by using the log-rank test. RESULTS During the follow-up period, 90 patients (27%) developed an incident cancer. Patient characteristics between groups differed, but matching was not possible because of the relatively small sample sizes. There was no difference in time to incident cancer (P = .14) or type of incident cancer (P = .61) among the 4 groups. After adjusting for recurrence risk for type of prior cancer, there was no difference in risk of incident cancer (HR for anti-TNF, 0.32; 95% confidence interval [CI], 0.09-1.09; HR for anti-TNF with an antimetabolite, 0.64; 95% CI, 0.26-1.59; HR for an antimetabolite, 1.08; 95% CI, 0.54-2.15) or time to subsequent cancer between study arms (P = .22). CONCLUSION On the basis of a retrospective study, in patients with IBD and a history of cancer, exposure to an anti-TNF agent or an antimetabolite after cancer was not associated with an increased risk of incident cancer, compared with patients who did not receive immunosuppression. Larger, matched, prospective studies are needed to confirm these findings.
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Affiliation(s)
- Jordan Axelrad
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian/Columbia University Medical Center, New York, New York
| | - Oren Bernheim
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stefano Malerba
- Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ashwin Ananthakrishnan
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts
| | - Vijay Yajnik
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts
| | - Gila Hoffman
- Albert Einstein College of Medicine, New York, New York
| | - Manasi Agrawal
- Department of Medicine, Montefiore Medical Center, New York, New York
| | - Dana Lukin
- Division of Gastroenterology and Liver Diseases, Department of Medicine, Montefiore Medical Center, New York, New York
| | - Amit Desai
- Division of Gastroenterology and Hepatology, Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, New York
| | | | - Brian Bosworth
- Division of Gastroenterology and Hepatology, Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Ellen Scherl
- Division of Gastroenterology and Hepatology, Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Andre Reyes
- Department of Medicine, North Shore-Long Island Jewish University Hospital, Manhasset, New York
| | - Hina Zaidi
- Division of Gastroenterology, Department of Medicine, North Shore-Long Island Jewish North Shore University Hospital, Manhasset, New York
| | - Prashant Mudireddy
- Division of Gastroenterology, Department of Medicine, North Shore-Long Island Jewish Lenox Hill Hospital, New York, New York
| | - David DiCaprio
- Department of Medicine, North Shore- Long Island Jewish Lenox Hill Hospital, New York, New York
| | - Keith Sultan
- Division of Gastroenterology, Department of Medicine, North Shore-Long Island Jewish North Shore University Hospital, Manhasset, New York
| | - Burton Korelitz
- Division of Gastroenterology, Department of Medicine, North Shore-Long Island Jewish Lenox Hill Hospital, New York, New York
| | - Erwin Wang
- Department of Medicine, NYU Langone Medical Center, New York, New York
| | - Renee Williams
- Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, New York, New York
| | - LeaAnn Chen
- Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, New York, New York
| | - Seymour Katz
- Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, New York, New York
| | - Steven Itzkowitz
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
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Annese V, Beaugerie L, Egan L, Biancone L, Bolling C, Brandts C, Dierickx D, Dummer R, Fiorino G, Gornet JM, Higgins P, Katsanos KH, Nissen L, Pellino G, Rogler G, Scaldaferri F, Szymanska E, Eliakim R. European Evidence-based Consensus: Inflammatory Bowel Disease and Malignancies. J Crohns Colitis 2015; 9:945-65. [PMID: 26294789 DOI: 10.1093/ecco-jcc/jjv141] [Citation(s) in RCA: 293] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/10/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Vito Annese
- University Hospital Careggi, Department of Gastroenterology, Florence, Italy
| | - Laurent Beaugerie
- Department of Gastroenterology, AP-HP Hôpital Saint-Antoine, and UPMC Univ Paris 06, Paris, France
| | - Laurence Egan
- Pharmacology and Therapeutics, School of Medicine, National University of Ireland, Galway, Ireland
| | - Livia Biancone
- University Tor Vergata of Rome, GI Unit, Department of Systems Medicine, Rome, Italy
| | - Claus Bolling
- Agaplesion Markus Krankenhaus, Medizinische Klinik I, Frankfurt am Main, Germany
| | - Christian Brandts
- Department of Medicine, Hematology/Oncology, Goethe University, Frankfurt am Main, Germany
| | - Daan Dierickx
- Department of Haematology, University Hospital Leuven, Leuven, Belgium
| | - Reinhard Dummer
- Department of Dermatology, University Zürich, Zürich, Switzerland
| | - Gionata Fiorino
- Gastroenterology Department, Humanitas Research Hospital, Rozzano, Italy
| | - Jean Marc Gornet
- Service d'hépatogastroentérologie, Hopital Saint-Louis, Paris, France
| | - Peter Higgins
- University of Michigan, Department of Internal Medicine, Ann Arbor, USA
| | | | - Loes Nissen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gianluca Pellino
- Second University of Naples, Unit of Colorectal Surgery, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Naples, Italy
| | - Gerhard Rogler
- Klinik für Gastroenterologie und Hepatologie, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Franco Scaldaferri
- Università Cattolica del Sacro Cuore, Department of Internal Medicine, Gastroenterology Division, Roma, Italy
| | - Edyta Szymanska
- Department of Pediatrics, Nutrition and Metabolic Disorders, Children's Memorial Health Institute, Warsaw, Poland
| | - Rami Eliakim
- Department of Gastroenterology and Hepatology, Sheba Medical Center & Sackler School of Medicine, Israel
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38
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Lawlor G, Katz S. Management of IBD in the Elderly Patient With Cancer. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2015; 13:301-307. [PMID: 26135089 DOI: 10.1007/s11938-015-0061-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The management of inflammatory bowel disease (IBD) in patients with known or recently treated cancer has become a common dilemma in our ageing population. Older patients are commonly excluded from prospective trials, and co-morbid status and polypharmacy may muddy our understanding of the impact of therapies on these patients. Immunosuppression (anti-TNF therapy, antimetabolite therapy) carries a relative contra-indication in the setting of known cancer as it is expected to increase cancer risk and increase propagation of in situ cancer. Recent studies have sought to investigate this risk by looking from two sides-the impact of cancer therapies on IBD outcomes and the risk of cancer occurrence/recurrence in patients on IBD therapies. In this chapter, we review this data and determine the safety of commonly used IBD therapies in this potentially vulnerable elderly population.
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Affiliation(s)
- Garrett Lawlor
- Inflammatory Bowel Disease Program, Columbia University Medical Center, 161 Fort Washington Ave, Suite 862, New York, NY, 10032, USA,
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Scott FI, Vajravelu RK, Bewtra M, Mamtani R, Lee D, Goldberg DS, Lewis JD. The benefit-to-risk balance of combining infliximab with azathioprine varies with age: a markov model. Clin Gastroenterol Hepatol 2015; 13:302-309.e11. [PMID: 25117775 PMCID: PMC4324381 DOI: 10.1016/j.cgh.2014.07.058] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/21/2014] [Accepted: 07/31/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Combination therapy with infliximab and azathioprine has demonstrated benefit over monotherapy for moderate-to-severe Crohn's disease. Clinical trials and models have not accounted for age-specific risks associated with these therapies, including the risk of immunosuppression-related cancer and infection. After accounting for these risks, the strategy yielding the greatest benefit may vary with age. METHODS We assessed age-specific risks and benefits of combination therapy compared with infliximab monotherapy by using Markov modeling. The base case was a 35-year-old male patient with a 1-year time horizon. We assumed the incidence of lymphoma to be 5.28-fold higher with combination therapy. Secondary analyses accounted for life expectancy, therapy beyond 1 year, and age-specific surgical and infection risks. Quality-adjusted life years (QALYs) were calculated for 25- to 75-year old individuals. RESULTS Combination therapy was found to be of greater benefit in the base case (0.7522 QALYs for combination therapy vs 0.7426 QALYs for monotherapy). Accounting for life years lost, monotherapy was the best approach if the hazard ratio for lymphoma with combination therapy was >8.1 patients who were 75 years old. Monotherapy provided greater net benefit to patients 55, 65, or 75 years old if therapy was extended for 9, 7, or 5 years, respectively. For 25-year-old men, monotherapy resulted in fewer deaths but only yielded greater QALYs if the annual incidence of hepatosplenic T-cell lymphoma exceeded 36/100,000 persons. CONCLUSIONS After accounting for age-specific risks of lymphoma, infection, and surgical complications, benefits of combination therapy outweighed the risks as a short-term and intermediate-term strategy for most patients with moderate-to-severe Crohn's disease who were younger than 65 years. For young male patients, combination therapy yields greater QALYs but at cost of an increased risk of death from lymphoma.
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Affiliation(s)
- Frank I Scott
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Ravy K Vajravelu
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Meenakshi Bewtra
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ronac Mamtani
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dale Lee
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Gastroenterology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David S Goldberg
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James D Lewis
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Impact of the diagnosis and treatment of cancer on the course of inflammatory bowel disease. J Crohns Colitis 2014; 8:819-24. [PMID: 24439392 DOI: 10.1016/j.crohns.2013.12.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 12/29/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND The effects of extra-intestinal cancer on the course of inflammatory bowel disease (IBD) are poorly understood. AIM To evaluate the impact of cancer and its management on IBD outcomes. METHODS A total 80 IBD patients (51 Crohn's disease, 29 ulcerative colitis; 33 men, median age at cancer diagnosis 48yrs) diagnosed with extra-intestinal cancer were selected from a prospective database. IBD activity and therapeutic requirements (assessed year-by-year) were compared before and after cancer diagnosis, with a control group of patients without cancer matched for gender, birth date, date of IBD diagnosis and IBD phenotype. RESULTS Paired comparisons of the consecutive periods before and after cancer diagnosis did not show significant changes in median (IQR) percentages of years with active disease (27% [0-50] vs. 19% [0-53]), while the proportion of patient-years on any immunosuppressant remained stable (26% vs. 28%). Chemotherapy had no significant effect on IBD activity. Compared to controls, patients with cancer had a similar IBD activity and use of anti-TNF, but less use of immunomodulators (19% vs. 25%, p<0,001) and an increased rate of surgery (4% vs. 2.5%, p<0,05). Individual variations in IBD activity after cancer diagnosis were not significantly different in patients with cancer and their matched controls. CONCLUSION Occurrence of extra-intestinal cancer impacts IBD therapeutic management, with a trend towards less use of immunomodulators and more surgery. In the long-term, cancer diagnoses and treatments do not modify IBD outcomes.
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Bernheim O, Colombel JF, Ullman TA, Laharie D, Beaugerie L, Itzkowitz SH. The management of immunosuppression in patients with inflammatory bowel disease and cancer. Gut 2013; 62:1523-8. [PMID: 23903238 DOI: 10.1136/gutjnl-2013-305300] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Oren Bernheim
- The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, , New York, New York, USA
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