The silent progression of metastatic malignancy during the treatment with soluble tumor necrosis factor receptor.
Etanercept is singular among anti-tumor necrosis factor alpha (TNF-alpha) agents, for being a soluble antibody to both TNF and lymphtoxin-alpha. The long-term neutralization of two cachexins by etanercept would theoretically compromise early detection of malignancy. This case reports a patient who was treated by etanercept for 21 months due to ankylosing spondylitis. Metastatic malignancy of unknown origin developed, and silently led the patient to lethal hepatic rupture. With an example of a malignancy masking effect of soluble TNF receptor, this article questions a need for vigilant attention to de novo carcinoma during the therapy, and calls for refined strategies in modulating autoimmune diseases.
Ahn
Inhye E
IE
Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea.
Ju
Ji Hyeon
JH
Kang
Kwi Young
KY
Park
Sung-Hwan
SH
Kim
Ho-Youn
HY
D000230:Adenocarcinoma / Q000556:secondary*; D000068800:Etanercept; D017809:Fatal Outcome; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008107:Liver Diseases / Q000473:pathology; D008113:Liver Neoplasms / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000473:pathology*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012422:Rupture, Spontaneous / Q000473:pathology; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000473:pathology
D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept