title: Risk of New or Recurrent Cancer in Patients With Inflammatory Bowel Disease and Previous Cancer Exposed to Immunosuppressive and Anti-Tumor Necrosis Factor Agents.
abstract: OBJECTIVE
  Our understanding of malignancy associated with immunosuppression in patients with inflammatory bowel disease (IBD) comes from studies of individuals with no history of cancer. We investigated whether patients with IBD and a history of cancer who were subsequently immunosuppressed have an increased risk of developing incident cancer.
  
  
  METHODS
  We performed a retrospective analysis of data from 333 patients with IBD treated at 8 academic medical centers who developed cancer and subsequently received treatment with anti-tumor necrosis factor (TNF), anti-TNF with an antimetabolite (thiopurines, methotrexate), antimetabolites, or no subsequent exposure to immunosuppressive agents (controls). We collected data on their primary outcomes of incident cancers (new or recurrent). Hazard ratios (HRs) were calculated by using Cox proportional hazards and Kaplan-Meier survival curves; study groups were compared by using the log-rank test.
  
  
  RESULTS
  During the follow-up period, 90 patients (27%) developed an incident cancer. Patient characteristics between groups differed, but matching was not possible because of the relatively small sample sizes. There was no difference in time to incident cancer (P = .14) or type of incident cancer (P = .61) among the 4 groups. After adjusting for recurrence risk for type of prior cancer, there was no difference in risk of incident cancer (HR for anti-TNF, 0.32; 95% confidence interval [CI], 0.09-1.09; HR for anti-TNF with an antimetabolite, 0.64; 95% CI, 0.26-1.59; HR for an antimetabolite, 1.08; 95% CI, 0.54-2.15) or time to subsequent cancer between study arms (P = .22).
  
  
  CONCLUSIONS
  On the basis of a retrospective study, in patients with IBD and a history of cancer, exposure to an anti-TNF agent or an antimetabolite after cancer was not associated with an increased risk of incident cancer, compared with patients who did not receive immunosuppression. Larger, matched, prospective studies are needed to confirm these findings.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian/Columbia University Medical Center, New York, New York.
authors.forename: Jordan
authors.initials: J
authors.lastname: Axelrad
authors.affiliation: Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Oren
authors.initials: O
authors.lastname: Bernheim
authors.affiliation: Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Jean-Frederic
authors.initials: JF
authors.lastname: Colombel
authors.affiliation: Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Stefano
authors.initials: S
authors.lastname: Malerba
authors.affiliation: Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Ananthakrishnan
authors.affiliation: Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts and Harvard Medical School, Boston, Massachusetts.
authors.forename: Vijay
authors.initials: V
authors.lastname: Yajnik
authors.affiliation: Albert Einstein College of Medicine, New York, New York.
authors.forename: Gila
authors.initials: G
authors.lastname: Hoffman
authors.affiliation: Department of Medicine, Montefiore Medical Center, New York, New York.
authors.forename: Manasi
authors.initials: M
authors.lastname: Agrawal
authors.affiliation: Division of Gastroenterology and Liver Diseases, Department of Medicine, Montefiore Medical Center, New York, New York.
authors.forename: Dana
authors.initials: D
authors.lastname: Lukin
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, New York.
authors.forename: Amit
authors.initials: A
authors.lastname: Desai
authors.affiliation: Weill Cornell Medical College, New York, New York.
authors.forename: Elisa
authors.initials: E
authors.lastname: McEachern
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, New York.
authors.forename: Brian
authors.initials: B
authors.lastname: Bosworth
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, New York.
authors.forename: Ellen
authors.initials: E
authors.lastname: Scherl
authors.affiliation: Department of Medicine, North Shore-Long Island Jewish University Hospital, Manhasset, New York.
authors.forename: Andre
authors.initials: A
authors.lastname: Reyes
authors.affiliation: Division of Gastroenterology, Department of Medicine, North Shore-Long Island Jewish North Shore University Hospital, Manhasset, New York.
authors.forename: Hina
authors.initials: H
authors.lastname: Zaidi
authors.affiliation: Division of Gastroenterology, Department of Medicine, North Shore-Long Island Jewish Lenox Hill Hospital, New York, New York.
authors.forename: Prashant
authors.initials: P
authors.lastname: Mudireddy
authors.affiliation: Department of Medicine, North Shore- Long Island Jewish Lenox Hill Hospital, New York, New York.
authors.forename: David
authors.initials: D
authors.lastname: DiCaprio
authors.affiliation: Division of Gastroenterology, Department of Medicine, North Shore-Long Island Jewish North Shore University Hospital, Manhasset, New York.
authors.forename: Keith
authors.initials: K
authors.lastname: Sultan
authors.affiliation: Division of Gastroenterology, Department of Medicine, North Shore-Long Island Jewish Lenox Hill Hospital, New York, New York.
authors.forename: Burton
authors.initials: B
authors.lastname: Korelitz
authors.affiliation: Department of Medicine, NYU Langone Medical Center, New York, New York.
authors.forename: Erwin
authors.initials: E
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, New York, New York.
authors.forename: Renee
authors.initials: R
authors.lastname: Williams
authors.affiliation: Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, New York, New York.
authors.forename: LeaAnn
authors.initials: L
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology, Department of Medicine, NYU Langone Medical Center, New York, New York.
authors.forename: Seymour
authors.initials: S
authors.lastname: Katz
authors.affiliation: Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: steven.itzkowitz@mountsinai.org.
authors.forename: Steven
authors.initials: S
authors.lastname: Itzkowitz
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: Crohn’s Disease; Drug; Tumor; Ulcerative Colitis