Division of Oncology, Department of Internal Medicine 1, Medical University Vienna, Austria.
Arthritis Res Ther. 2011 Jun 29;13(3):223. doi: 10.1186/ar3352.
Management of patients with inflammatory rheumatic disease and a history of (or even a current) malignant disease poses some particular challenges. As direct evidence of the risk of (recurrent or de novo) malignancy in patients with a history of malignant disease is scarce, such a risk may be estimated indirectly from the principal carcinogenicity of the respective drug to be used or (also indirectly) from cancer reactivation data from the transplant literature. In general, cancer risk is increased in patients receiving combination immunosuppressive treatment, but the risk in patients receiving individual drugs (with the exception of alkylating agents) remains entirely unclear. Indirect evidence supports the intuitive concept that the risk of cancer decreases over time after a successful cancer treatment. The only two studies in rheumatic patients with a cancer history were small and have not been able to show an increase in cancer reactivation. The risk of reactivation also depends on the site and location of the prior malignancy. In conclusion, the decision to treat a patient with a history of cancer immunosuppressively should be shared by the rheumatologist and the oncologist. Once the decision is established, such patients need intensive and close monitoring.
管理患有炎症性风湿病且有（甚至当前有）恶性病史的患者带来了一些特殊的挑战。由于患有恶性病史的患者（复发或新发）恶性肿瘤的风险的确切证据很少，因此可以根据将要使用的药物的主要致癌性或（也间接）从移植文献中的癌症再激活数据来间接估计这种风险。一般来说，接受联合免疫抑制治疗的患者癌症风险增加，但接受单一药物治疗的患者（烷化剂除外）的风险仍完全不清楚。间接证据支持这样一种直观的概念，即在成功治疗癌症后，癌症风险随时间降低。仅有两项针对有癌症病史的风湿病患者的小型研究未能表明癌症再激活的风险增加。癌症再激活的风险也取决于先前恶性肿瘤的部位和位置。总之，有癌症病史的患者是否应接受免疫抑制治疗应由风湿病学家和肿瘤学家共同决定。一旦做出决定，此类患者就需要进行强化和密切监测。
