Management of Inflammatory Bowel Disease Patients with a Cancer History

ISSN: 1873-5592 (Online)
ISSN: 1389-4501 (Print)


Volume 15, 14 Issues, 2014


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Editor-in-Chief:
Francis J. Castellino
Kleiderer-Pezold Professor of Biochemistry
Director, W.M. Keck Center for Transgene Research
Dean Emeritus, College of Science
230 Raclin-Carmichael Hall, University of Notre Dame
Notre Dame, IN 46556
USA


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Management of Inflammatory Bowel Disease Patients with a Cancer History

Author(s): Laurent Beaugerie

Affiliation: Service de Gastroentérologie et Nutrition, Hopital Saint-Antoine, 184 rue du faubourg Saint-Antoine, 75571 Paris Cedex 12, France.

Abstract

In Inflammatory Bowel Disease (IBD) patients, thiopurines promote carcinogenesis of Epstein-Barr Virus (EBV)-related lymphomas, non-melanoma skin cancers and urinary tract cancers, while anti-TNF agents could promote carcinogenesis of melanomas. Patients with IBD and previous cancer are at a higher risk of developing new or recurrent cancer than IBD patients without a history of cancer, irrespective of the use of immunosuppressants. In transplant recipients, the use of thiopurines is associated with a high rate of cancer recurrence, particularly within the first two years following transplantation. In patients with chronic inflammatory disease, limited data suggest that no dramatic incidence of cancer recurrence is associated with the use of thiopurines or anti-TNF agents. However, there is a rationale for a two-year drug holiday from immunosuppressants after the diagnosis and treatment of the majority of incident cancers, as often as possible. Extending the duration of the immunosuppressant drug holiday to 5 years in patients with previous cancers associated with a high risk of recurrence in the post-transplant state should be considered. The immunosuppressants that can be initiated or resumed after cancer treatment should be chosen according to the type of the previous cancer. All individual decisions should be made on a case-by-case basis, together with the oncologist, according to characteristics and expected evolution of the index cancer, expected impact of the immunosuppressants on cancer evolution, and intrinsic severity of IBD, with its associated risks.

Keywords: Biologics, cancer recurrence, immunosuppressive therapy, second cancer.

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Article Details

Volume: 15
Issue Number: 11
First Page: 1042
Last Page: 1048
Page Count: 7
DOI: 10.2174/1389450115666140821113330
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