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

  • 1Department of Medicine, VA North Texas Healthcare System, Dallas, TX, USA
  • 2Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
  • 3Department of Pharmacy, VA North Texas Healthcare System, Dallas, TX, USA
  • 4College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
  • 5Division of Gastroenterology, The University of Texas at Austin Dell Medical School, Austin, TX, USA


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.
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.
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).
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.


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