Background/Purpose: Biologic therapy for rheumatoid arthritis (RA) downregulates the immune response. Tumoral immunity is an important host mechanism against cancer progression, and for this reason, biologic therapy is often discontinued when a patient with RA develops cancer. Objectives: To determine the utilization of biologic therapy in patients with RA and cancer, after their cancer diagnosis.

Methods: We performed a retrospective cohort study of patients with RA and cancer seen at National Cancer Institute designated Comprehensive Cancer Center between 2002 and 2014. Patients were initially identified as having RA if they had a claim with a diagnostic code for RA (714) according to the International Classification of Diseases (ICD-9). Two independent reviewers examined all electronic medical records, and selected patients that fulfilled the following criteria in addition to a claim code: age ≥ 18 years, diagnosis of RA by a rheumatologist, and/or current or prior use of a DMARD or biologic agent. Patients with more than one primary or non-melanoma skin cancer were excluded. Descriptive statistics were generated to summarize patient characteristics, biologic use, and time to biologic therapy onset after cancer diagnosis. Kaplan-Meier methods were used to estimate time from biologic therapy onset to recurrence.

Results: 1719 patients met the inclusion criteria. Of these, 563 had received biologic therapy at any time, before and/or after cancer diagnosis. Most were female (72%), with a mean age at cancer diagnosis of 59 years (±13 years). Eighty-one had a follow-up of less than 3 months after cancer diagnosis and were not included in the analysis; 43 had discontinued biologic therapy before the cancer diagnosis; 313 were receiving biologic therapy at the time of cancer diagnosis, and in this group 225 (72%) discontinued therapy within 3 months of diagnosis, and 88 (28%) continued treatment. In addition, 126 patients initiated biologic therapy after their cancer diagnosis with a median of 8 years (range 0.04-39). Overall, 214/1719 (12%) of the patients with RA received a biologic after their cancer diagnosis. The most common tumor site among the 214 patients was breast (28%) followed by lymphoma and prostate in 7% each, and melanoma in 6%. Biologic therapies included: tumor necrosis factor inhibitors (TNFi) (88%), rituximab (7%), abatacept (4%), and tocilizumab (1%). Almost 20% switched biologic therapy at a later stage. Fifty-seven (27%) patients who received biologic therapy had active cancer or developed a recurrence during follow-up, and 14 (7%) died. Recurrence/active cancer rate was 12% in first year after starting biologic therapy (or after diagnosis of cancer if biologic had been continued), 16% by 2 years, and 33% by 5 years.

Conclusion: Biologic therapy was used in 12% of patients with RA after their cancer diagnosis, most frequently TNFi. One third had active cancer or a recurrence during follow-up. Additional controlled studies are needed to determine if the risk of cancer recurrence is higher in patients with RA receiving biologic therapy after developing cancer.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/utilization-of-biologic-therapy-in-patients-with-rheumatoid-arthritis-and-cancer/