A recent population-based cohort study lends statistical support to prior observations that patients with a history of cancer who are treated with TNF inhibitors for inflammatory disorders face no associated risk of recurrent or new cancers.
Studies examining whether anti-TNF therapies affect the risk of recurrent or new primary cancer development among patients with a history of cancer are limited, write authors led by Akbar Waljee, M.D., of the VA Ann Arbor Healthcare System. Although several observational studies have suggested no such associations, they lack statistical power to guide clinical practice and fail to address questions such as whether physicians should withhold anti-TNF therapy for a minimum time period after someone develops an initial cancer.
"Our real-life observational study provides the scale and duration of follow-up needed to address the safety of anti-TNFα therapy in people with a history of cancer, with a hazard ratio (HR) of 0.82 (95% confidence interval 0.61-1.11) for recurrent or new primary cancers in patients with inflammatory bowel disease (IBD), rheumatoid arthritis (RA) or psoriasis exposed to anti-TNFα therapies," write Waljee et al.
The study is very reassuring, says Steven R. Feldman, M.D., Ph.D., who was not involved with the research.
"People worry that if you affect the immune system, you're going to increase cancer risks. We worry less with the more targeted treatments that we have nowadays like the interleukin-17 (IL-17) drugs and IL-23 drugs. But it's nice to know that if there's an increased risk of cancer with TNF inhibitors, it's too small to detect, even with a very large study," says Dr. Feldman, professor of dermatology, pathology and public health at Wake Forest University School of Medicine.
Dr. Feldman has received research, speaking and/or consulting support from Abbvie, Advance Medical, Almirall, Alvotech, Boehringer Ingelheim, BMS, Caremark, Celgene, Eli Lilly, Galderma, GSK/Stiefel, Janssen, LEO Pharma, Menlo, Merck, Mylan, National Biological Corporation, Novan, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi, Samsung, Sun Pharma, Suncare Research and Qurient. He also consults for other organizations through Guidepoint, Gerson Lehrman Group and other consulting organizations.
Waljee AK, Higgins PDR, Jensen CB, et al. Anti-tumor necrosis factor-α therapy and recurrent or new primary cancer in patients with inflammatory bowel disease, rheumatoid arthritis, or psoriasis and previous cancer in Denmark: a nationwide, population-based cohort study. Lancet Gastroenterol Hepatol. 2019 Dec 10. pii: S2468-1253(19)30362-0. doi: 10.1016/S2468-1253(19)30362-0. [Epub ahead of print]