Op0045 eular Points to Consider on the Initiation of Targeted Therapies in Patients With Inflammatory Arthritides and a History of Cancer

Abstract

BackgroundPotential associations between targeted therapies and a new cancer in patients with an inflammatory arthritis (IA) and a history of malignant disease are a frequent concern in daily rheumatology practice. IA and/or immunomodulatory drugs might confer a specific risk of malignancy. No evidence-based framework has been proposed to guide clinicians on the benefit/risk balance when initiating or reinitiating a targeted therapy (bDMARDs/tsDMARDs) in this context.ObjectivesThis initiative aimed to develop points to consider (PTC) to assist rheumatologists.when initiating/reinitiating a targeted therapy in the context of a previous malignancy.MethodsFollowing EULAR standardised operating procedures, a task force of 2 patient representatives.and 25 experts (comprising 2 methodologists, 2 EMEUNET members, 1 oncologist.and 20 rheumatologists) first met to define the research questions for a systematic literature review concerning patients with IA and a history of cancer and other relevant information for consideration including: incidence of cancer in targeted therapy-treated patients and no history of cancer, translational research in onco-rheumatology, management with targeted therapy of immune-related adverse events of checkpoint inhibitors. In a second meeting, the task force formulated.the overarching principles and the PTC.ResultsThe group formulated 5 overarching principles and 8 PTC relevant to the initiation of targeted therapies in patients with IA and a history of cancer. Major themes included a) the need to assess.the individualized risk of cancer recurrence based on the characteristics of the patient, the cancer and the underlying disease; b) the importance of engaging with specialists caring for the cancer and.to define treatment based on a shared decision between the patient and the rheumatologist;c) the possibility to initiate without delay an appropriate targeted therapy for the treatment of.the IA in patients in remission of their cancer; d) the proposal to prefer anti-cytokine bDMARDs.over other treatment options in patients with history of solid cancer and to prefer.B cell depleting therapy in patients with a history of lymphoma; e) the proposal to use JAK inhibitors and abatacept with caution, and only in the absence of therapeutic alternatives, based on.the significant increase in cancer incidence in patients without a history of cancer, with tofacitinib compared to anti-TNF in a randomized clinical trial, and a modest but significant increase.with abatacept compared to other bDMARDs in some observational studies.ConclusionThe 2023 EULAR Points to Consider provide guidance on the management of targeted therapies.in patients with IA and a history of cancer. The research agenda highlights the need for studies.to evaluate targeted therapies other than TNF inhibitors and anti-CD20 to address the evidence gaps in this setting.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsEden Sebbag: None declared, Kim Lauper: None declared, Juan Molina Collada: None declared, Daniel Aletaha: None declared, Johan Askling: None declared, Karolina Benesova: None declared, Heidi Bertheussen: None declared, Samuel Bitoun: None declared, Ertugrul Cagri Bolek: None declared, Gerd Rüdiger Burmester: None declared, Helena Canhão: None declared, Katerina Chatzidionysiou: None declared, Jeffrey Curtis: None declared, François-Xavier Danlos: None declared, vera guimaraes: None declared, Merete Lund Hetland: None declared, Florenzo Iannone: None declared, Marie Kostine: None declared, Tue Wenzel Kragstrup: None declared, Tore K. Kvien Speakers bureau: Grünenthal, Sandoz, UCB, Consultant of: AbbVie, Amgen, Celltrion, Gilead, Novartis, Pfizer, Sandoz, UCB, Grant/research support from: AbbVie, Amgen, BMS, Galapagos, Novartis, Pfizer, UCB, Anne Regierer: None declared, Hendrik Schulze-Koops: None declared, Lucía Silva-Fernández Speakers bureau: Lilly, BMS, Abbvie, Novartis, Janssen., Consultant of: Novartis, MSD, Sanofi, Janssen, Pfizer, Zoltan Szekanecz: None declared, Maya H Buch: None declared, Axel Finckh Speakers bureau: AbbVie BMS, Pfizer Eli-Lilly Sandoz, Consultant of: AbbVie, Novartis, Pfizer, MSD, Lilly, Grant/research support from: AbbVie, BMS, Galapagos, Lilly, Pfizer, Jacques-Eric Gottenberg Consultant of: Abbvie, BMS, Galpagos, Gilead, Lily, Pfizer, Roche Chugai, Sanofi, UCB, Grant/research support from: Abbvie, BMS, Pfizer.