Intest Res.  2020 Jul;18(3):282-288. 10.5217/ir.2019.09140.

Safety of tumor necrosis factor inhibitor use in patients with concomitant malignancy

• Phan H
• Weideman RA
• Cipher DJ
• Feagins LA

• KMID: 2504583
• DOI: http://doi.org/10.5217/ir.2019.09140

Abstract

Background/Aims
Safety for tumor necrosis factor inhibitors (TNFi) in cancer has been focused on risk of incident malignancies, but studies on prognostic effects have been scarce. We determined survival and recurrence rates at 1, 2, and 5 years after cancer diagnosis in patients with and without concurrent TNFi use.
Methods
Chart reviews were performed between 1996 and 2015 at the VA North Texas Healthcare System. Cases were patients with inflammatory disease, concomitant malignancy, and TNFi use while controls were patients with inflammatory disease, concomitant malignancy but no TNFi use. Cases and controls were matched for type of malignancy. Analysis was performed with log-rank tests on Kaplan-Meier curves.
Results
Thirty-six cases and 72 controls were identified. For cases, survival at 1, 2, and 5 years were 32 (89%), 31 (86%), and 29 (81%) compared to 63 (90%), 61 (87%), and 51 (73%) for the control group (P=0.985). For cases, recurrence rates at 1, 2, and 5 years were 3 (8%), 5 (14%), and 6 (17%) compared to 2 (3%), 5 (7%), and 7 (10%) for the control group (P=0.158).
Conclusions
Our findings suggest TNFi may be safely used in select inflammatory disease patients with concurrent cancer if therapy is needed for proper disease control. However, case-by-case consideration in conjunction with an oncologist is recommended while considering the apparent safety of TNFi for patients suffering from active inflammatory diseases despite having a concomitant malignancy.

Keyword

Tumor necrosis factor inhibitor; Neoplasms; Inflammatory bowel disease; Arthritis, rheumatoid

Figure

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  Fig. 1. Survival after cancer diagnosis compared between patients exposed or not exposed to TNF inhibitors (TNFi). The probability of accelerated mortality did not significantly differ between the TNFi exposed and TNFi naïve groups. χ²(1)=0.0, P=0.985.

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  Fig. 2. Survival rates for cases (TNFi exposed) compared with the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) national data matched for gender, cancer type and diagnosis year. TNFi, TNF inhibitors.

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  Fig. 3. Cancer recurrence rates after initial cancer diagnosis compared between patients exposed or not exposed to TNF inhibitors (TNFi). The probability of accelerated recurrence also did not significantly differ between the TNFi exposed and TNFi naïve groups. χ²(1)=2.0, P=0.158.

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  Fig. 4. Cancer recurrence rates after initial cancer diagnosis compared between patients treated with TNF inhibitors (TNFi) that was discontinued at cancer diagnosis and not restarted compared to patients who continued or restarted TNFi soon after cancer diagnosis. Kaplan-Meier analysis indicated that there was no significant difference between the cases and controls in accelerated recurrence. χ²(1)=0.57, P=0.45.

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