Impact of the diagnosis and treatment of cancer on the course of inflammatory bowel disease

Rajca, Sylvie; Seksik, Philippe; Bourrier, Anne; Sokol, Harry; Nion–Larmurier, Isabelle; Beaugerie, Laurent; Cosnes, Jacques

doi:10.1016/j.crohns.2013.12.022

Cited by 29 publications

(25 citation statements)

References 28 publications

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“…[11][12][13][14][15][16][17][18][19] Few studies have examined the effect of cancer on IBD, but there is emerging evidence that a diagnosis of cancer may significantly influence further therapeutic strategies for IBD. 26,27 Our observations may support the practice of continuing immunosuppression for IBD when patients are in remission from an underlying malignancy. However, patients exposed to immunosuppression in our study had a history of less advanced primary cancers compared with controls.…”

Section: Discussionmentioning

confidence: 58%

Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents

Axelrad

Bernheim

Colombel

et al. 2016

Clinical Gastroenterology and Hepatology

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Section: Discussionmentioning

confidence: 58%

Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents

Axelrad

Bernheim

Colombel

et al. 2016

Clinical Gastroenterology and Hepatology

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“…It should also be noted that the evolution of IBD in patients with prior malignancy from the St-Antoine cohort was not found different from that of IBD controls [36] , although in the former population there was a lower use of IS and higher rates of surgery ( fig. 1 ).…”

Section: Prognostic Factors In Ibdmentioning

confidence: 99%

What Should Be Done in Inflammatory Bowel Disease Patients with Prior Malignancy?

Cosnes

2017

Dig Dis

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Background: Treatment of inflammatory bowel disease (IBD) in patients with prior malignancy is challenging because therapeutic immunosuppression required for controlling IBD activity may increase the risk of cancer recurrence. Key Messages: Contrary to the observations in the post-transplant population, retrospective observational studies of IBD patients with prior malignancy have not demonstrated that immunosuppressive drugs increased significantly the risk of new or recurrent cancer. However, these studies are highly biased and do not permit the use of these drugs. Factors like the time since treatment completion, severity, and subtype of prior cancer should be weighed along with the current IBD activity before choosing the best therapeutic strategy. In practice, most cases of prior cancer require a delay of at least 2 years before starting or resuming immunosuppressants, including anti-TNF agents. This delay should be extended to 5 years in cancer with a high risk of recurrence including cancer of the urinary tract, gastrointestinal cancer, leukemias, and multiple myeloma. A special attention should be paid to cancers with a high risk of late metastasis (breast, melanoma, renal cell carcinoma). Enteral nutrition, Budesonide, mesalamine, and limited intestinal resection should be considered following the completion of cancer treatment and prior to the safe initiation of immunosuppressive treatment for IBD. Thiopurines should be avoided in case of prior Epstein-Barr virus-related lymphoma, HPV-related carcinomas, and cancer of the urinary tract. Methotrexate and anti-TNF agents seem to be safe except for the risk of recurrent melanoma for the latter. Conclusion: IBD patients with prior malignancy should benefit from individual decisions made on a case-by-case basis.

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“…7,8 However, very few have addressed cancer-specific outcomes, chemotherapy tolerance, and survival in patients with IBD. A study of 19 patients with IBD and gastrointestinal malignancy treated with 5-fluorouracil (5-FU)–based chemotherapy reported an increased risk of severe diarrhea (n = 10, 53%) resulting in discontinuation of therapy in 5 patients and dose reduction in another 5 patients.…”

Section: Introductionmentioning

confidence: 99%

Chemotherapy Tolerance and Oncologic Outcomes in Patients With Colorectal Cancer With and Without Inflammatory Bowel Disease

Axelrad

Kriplani

Özbek

et al. 2017

Clinical Colorectal Cancer

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Inflammatory bowel disease (IBD) is a risk factor for colorectal cancer (CRC). We evaluated chemotherapy tolerance and oncologic outcomes from the medical records of patients with CRC with and without IBD. In this series, patients with CRC with IBD experienced more treatment alterations than those without IBD. Patients with stage IV CRC with IBD had shorter survival than patients without IBD. 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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Impact of the diagnosis and treatment of cancer on the course of inflammatory bowel disease

Abstract: 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.

Cited by 29 publications

References 28 publications

Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents

Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents

What Should Be Done in Inflammatory Bowel Disease Patients with Prior Malignancy?

Chemotherapy Tolerance and Oncologic Outcomes in Patients With Colorectal Cancer With and Without Inflammatory Bowel Disease

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