Immunosuppression & cancer recurrence

October 24, 2023

Issue 20

Clinical Question

Do immunosuppressants increase risk of cancer recurrence?

Editor’s Bottom Line

These data provide reassurance that IBD therapies do not affect rates of cancer recurrence, although more data on some less common malignancies are needed.

Reference

Gupta A, Peyrin-Biroulet L, Ananthakrishnan AN. Risk of Cancer Recurrence in Patients with Immune-Mediated Diseases with Use of Immunosuppressive Therapies: An Updated Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol. Epub ahead of print August 12, 2023; 

Synopsis

To examine the risk of cancer recurrence in patients with a history of malignancies receiving immunosuppressive therapy, researchers conducted a meta-analysis of 29 studies examining the question. Seventeen studies were conducted in IBD patients, 14 were conducted in rheumatoid arthritis patients, two studies included individuals with psoriasis, and one was conducted in patients with ankylosing spondylitis. A total of 24,328 individuals with a history of cancer prior to treatment for their immune-mediated disease were included, amounting to 85,784 person-years of follow-up after the prior diagnosis of cancer.

Individuals received anti-tumor necrosis factor (TNF) agents, non-biologic immunosuppressants,  combination therapy or no immunosuppression.

Pooled analysis showed that cancers recurred at similar rates among those receiving anti-TNFs (571 cancers over 17,772 patient years; 32 cases per 1,000 patient years; 95% Confidence Interval [CI], 25–38), non-anti-TNF immunosuppressive agents (1,104 incident cancers over 17,018 patient years; 46/1,000 patient years; 95% CI, 31–61), combination therapy (179 incident cancers over 2,659 patient years; 56/1,000 patient years; 95% CI, 31–81) and among those not receiving immunosuppression (1,627 incident cancers in 43,765 patient years; 35/1,000 patient years; 95% CI 27–43).

Patients receiving ustekinumab (5 incident cancers over 213 patient years or 21/1,000 patient years;  5% CI, 0–44) and vedolizumab (37 incident cancers over 1,951 patient years; 16/1,000 patient years; 95% CI, 5–26) had a numerically lower risk of cancer than other patients.

The authors did not find studies examining the topic in patients receiving Janus kinase inhibitors.

Details

Study Design: Meta-analysis

Funding: Crohn’s and Colitis Foundation and the Chleck Family Foundation

Allocation: Not applicable

Setting: Multicenter

Level of Evidence: 2a