Background/Purpose

A few is known about the effects of biologic therapy in patients with a history of a solid cancer. According to the 2012 updated American College of Rheumatology Recommendations, it is possible to start or resume any biologic agent in patients who have been treated for solid tumor (level of evidence C). But, there is no evidence in patients with history of a solid cancer within the past 5 years because of the lack of studies examining the risk of recurrent cancer in this subgroup. The purpose of this study was to explore the influence of TNF inhibitor (TNFi) therapy in patients with prior cancer treatment within the past 5 years.

Methods

The medical records of all patients (n=859) that received TNFi therapy at a single rheumatology clinic between June 2005 and May 2014 were retrospectively reviewed. Among them, data from patients who had a history of solid cancer treatment before TNFi therapy were collected and patient outcomes were evaluated especially for those who have been treated cancer within the last 5 years.

Results

Of 859 patients who underwent TNFi therapy, 22 patients (1 on infliximab, 11 on etanercept, 7 on adlimumab and 3 on golimumab) had a history of malignancy before initiating TNFi therapy for ankylosing spondylitis (AS) and rheumatoid arthritis (RA) (Table 1). The median AS, RA disease duration was 8 (3.75-12.25) years and median time to TNFi therapy after prior cancer treatment was 62.5 (21.25-140.25) months. Most common site of prior cancer is stomach (36.4%) and followed by thyroid, colorectum, liver, kidney, and breast. There was no recurrence of previous cancer during 40 (7.0-50.75) months of TNFi therapy. Especially, 10 patients started TNFi therapy before 5 years prior cancer treatment (Table 2). All of our 10 cases were limited in an early stage without distant metastasis. When they have been followed for 36 months, recurrence of cancer was not found.

Conclusion

Our results suggest that starting TNFi therapy in patients with history of solid cancer in locally limited stage is safe even less than 5 years after prior cancer treatment.

Table 1. Clinical characteristics of patients with prior cancer history when starting TNFi
characteristics									patients(n=22)
Age, mean(range), years									63 (41-81)
Sex, female, n (%)									15 (68.2)
Diagnosis, n (%)
AS									8 (36.4)
RA									14 (63.6)
Disease duration of AS and RA, median(IQR), years									8 (3.75-12.25)
Time to TNFi therapy after prior cancer treatment , median(IQR), month									62.5 (21.25-140.25)
TNFi, n (%)
infliximab									1 (4.5)
etanercept									11 (50)
adalimumab									7 (31.8)
golimumab									3 (13.6)
Site of prior cancer, n (%)
stomach									8 (36.4)
colon,rectum									2 (9.1)
gallblader									1 (4.5)
liver									2 (9.1)
kidney									2 (9.1)
breast									2 (9.1)
skin (non melanoma)									1 (4.5)
cervix									1 (4.5)
thyroid									3 (13.6)
Duration of TNFi use, median(IQR), month									40.0 (7.0-50.75)
Incidence of cancer recur, n (%)									0 (0)
AS: ankylosing  spondylitis, RA: rheumatoid arthritis, IQR: interquartile range, TNFi: TNF inhibitor

Table 2. clinical characteristics of 10 patients  who starting TNFi less than 5 years after prior cancer treatment
Age,years /sex	diagnosis	site of prior cancer	type/ staging	treatment	time to TNFi therapy after prior cancer treatment, month	TNF inhibitor	duration of TNFi use, month	cancer recur
60/F	RA	liver	HCC T1N0M0	surgical resection	1	A	75	No
41/F	RA	stomach	MALToma low grade	H.pyrori eradication	42	A	64	No
73/F	RA	thyroid	PTC T3N0M0	surgical resection, RAI	8	G	7	No
78/F	RA	skin	BCC	surgical resection	2	E	45	No
44/M	AS	stomach	AGC T2N0M0	surgical resection, adjuvant chemo	22	E	213	No
62/F	AS	kidney	RCC T1N0M0	surgical resection	47	E	56	No
72/M	RA	stomach	AGC (?)	surgical resection	47	E	7	No
51/M	AS	stomach	AGC T2N1M0	surgical resection	19	A	27	No
67/F	RA	thyroid	PTC T1N0M0	surgical resection, RAI	18	I	7	No
63/F	AS	colon	colon cancer T2N1M0	surgical resection, adjuvant chemo	36	G	6	No
TNFi: TNF inhibitor, RA: rheumatoid arthritis, AS: ankylosing spondylitis, HCC: hepatocelluar carcinoma
MALToma: extranodal marginal zone B cell lymphoma, PTC: papillary thyroid cancer, BCC: basal cell carcinoma
AGC: andvanced gastric cancer, RCC: renal cell carcinoma, RAI: radioactive iodine, chemo: chemotherapy
A: adalimumab, E: etanercept, G: golimumab, I: infliximab

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/safety-of-tnf-inhibitor-therapy-in-patients-who-have-had-a-prior-malignancy/