Hormone Therapy for Cancer Is a Risk Factor for Relapse of Inflammatory Bowel Diseases

Abstract

Background & Aims: Exposure to hormone contraception has been associated with an increased risk of relapse of inflammatory bowel diseases (IBD). 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 following 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.

Sex-based differences in inflammatory bowel diseases: a review

“…52 These findings are in contrast to a larger, multicenter retrospective study of both men and women with IBD that demonstrated a twofold increased risk of IBD flare associated with hormone therapy following a diagnosis of prostate or breast cancer. 53 Unfortunately, the risk was not reported separately among men versus women. The data regarding the role of male sex hormones in IBD pathogenesis and disease course are sparse and warrant investigation.…”

Advanced therapies in inflammatory bowel disease: Special considerations

“…In the setting of cytotoxic chemotherapy use, cessation of IBD immunosuppression (excluding gut-selective agents such as vedolizumab for non-GI cancers) is generally recommended and indeed may not be required given the potential benefit of cytotoxic chemotherapy for IBD activity. 7 Timing of the resumption of IBD therapy following completion of therapy requires consideration on an individual basis.…”

“…The management of IBD in the setting of a current cancer may be more challenging and is influenced by the severity of IBD activity, the cancer therapy, and the individual's overall prognosis and quality of life. In the setting of cytotoxic chemotherapy use, cessation of IBD immunosuppression (excluding gut‐selective agents such as vedolizumab for non‐GI cancers) is generally recommended and indeed may not be required given the potential benefit of cytotoxic chemotherapy for IBD activity 7 . Timing of the resumption of IBD therapy following completion of therapy requires consideration on an individual basis.…”

Challenges in the Management of Inflammatory Bowel Disease

“…Thiopurines remain the culprit with non-melanotic skin cancer (Peyrin-Biroulet et al 2011) and lymphoma (Beaugerie et al 2009). There is an increased IBD relapse rate associated with hormonal therapy in breast or prostate cancer (Axelrad et al 2019).…”