title: Rapid onset of cutaneous squamous cell carcinoma in patients with rheumatoid arthritis after starting tumor necrosis factor alpha receptor IgG1-Fc fusion complex therapy.
abstract: Tumor necrosis factor alpha (TNF-alpha) is now believed to be a major contributor to the pathogenesis of the synovitis and joint destruction in rheumatoid arthritis. Etanercept is a recombinant human TNF-alpha receptor Fc fusion protein consisting of a dimer of the extracellular portion of two p75 TNF-alpha receptors fused to the Fc portion of human IgG1. Etanercept produces significant dose-dependent improvements in disease activity. We describe 7 patients who experienced 1 or more squamous cell carcinomas that showed rapid growth and arose over a 2- to 4-month period of etanercept therapy. Soluble TNF-alpha receptor therapy through inhibition of a T(H)1 cytokine pattern and inhibition of the direct and indirect cytotoxic effects of TNF-alpha may initially decrease mechanisms for controlling subclinical tumors and may contribute to the histologic features seen within these tumors. However, prolonged TNF-alpha inhibition may have some antitumor effects.
authors.affiliation: Department of Dermatology, National Naval Medical Center, Bethesda, Maryland 20889-5600, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Smith
authors.forename: H G
authors.initials: HG
authors.lastname: Skelton
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002294:Carcinoma, Squamous Cell / Q000209:etiology* / Q000473:pathology; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor; D012878:Skin Neoplasms / Q000209:etiology* / Q000473:pathology
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept