[Does TNF play a role in the pathogenesis of solid tumors?].

Tumor necrosis factor (TNF)-alpha blocking agents play an important role in rheumatology. For this reason, questions about the pathogenic characteristics of TNF in carcinogenesis are of the utmost importance. The observation that TNF leads to necrosis in tumor tissue gave rise to the hope that an agent had been identified for the treatment of malignant tumors. However, this expectation remained unfulfilled, not the least due to the toxicity of systemically applied TNF. In addition, TNF is produced by many tumor cells. There is evidence that for some tumors TNF promotes tumor growth, invasiveness and metastasis. It is quite possible, therefore, that the inhibition of TNF-alpha has an inhibitive effect on carcinogenesis and/or tumor progression. In 2009 the US Food and Drug Administration (FDA) issued a cancer warning for the use of TNF inhibitors in children and adolescents. There is still some controversy as to whether TNF blocking therapy, co-medication or the rheumatic disease itself leads to an increased cancer risk in these young patients. In adults, safety information so far available suggests a favorable risk-benefit profile for the long-term use of TNF inhibitors. However, many questions remain unanswered as to the role TNF itself plays in the pathogenesis of solid tumors.