Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
Sección Reumatología, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina.
Clin Rheumatol. 2020 Mar;39(3):787-794. doi: 10.1007/s10067-019-04874-x. Epub 2019 Dec 18.
Biologic disease-modifying anti-rheumatic drugs (bDMARDs) interfere with the immune system and could theoretically increase risk of malignancies. However, recent evidence has not substantiated such concerns and physicians are less reluctant in treating patients with underlying cancer with such bDMARDs. We aimed to understand the current utilization patterns of bDMARDs for the treatment of rheumatoid arthritis (RA) in cancer patients.
We performed a retrospective cohort study of patients with prevalent RA and cancer initially seen at MD Anderson Cancer Center between 2002 and 2014. A cohort of cancer patients was identified from the tumor registry, and patients with RA were identified through ICD-9 codes, followed by review of electronic medical records. We included patients 18 years and older, with a cancer diagnosis, and a diagnosis of RA by a rheumatologist. Patients were followed until 2016.
We identified 431 patients with RA and cancer that met our inclusion criteria. Overall, 111 (26%) received bDMARDs after their cancer diagnosis; of these, 60 (54%) had received bDMARDs prior to their cancer diagnosis and continued to receive this therapy following their diagnosis. Thirteen (22%) switched to a different bDMARD, and the rest continued to receive the same agent after their cancer diagnosis. Of all patients on a bDMARD, 91 (82%) received tumor necrosis factor inhibitors (TNFi).
The treatment landscape of patients with a history of cancer and RA is changing. Future studies evaluating the safety of bDMARDs in patients with a recent history of cancer or with active cancer are needed. Part of the data of this project was presented as a poster at the 2016 American College of Rheumatology annual meeting. Zamora NV, Siddhanamatha H, Barbo A, Tayar J, Lin H, Suarez-Almazor M. Utilization of Biologic Therapy in Patients with Rheumatoid Arthritis and Cancer [abstract].Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/utilization-of-biologic-therapy-in-patients-with-rheumatoid-arthritis-and-cancer/. Accessed September 30, 2019. Key Points • One in four patients with RA and concomitant cancer received bDMARDs, including TNFi, after their cancer diagnosis, at our institution. • Half of the patients with RA and cancer who received bDMARDs had initiated therapy prior to the cancer diagnosis, continuing thereafter.
生物疾病修饰抗风湿药物（bDMARDs）会干扰免疫系统，理论上会增加恶性肿瘤的风险。然而，最近的证据并没有证实这些担忧，医生在治疗患有潜在癌症的患者时也不再那么不愿意使用此类 bDMARDs。我们旨在了解癌症患者中 bDMARD 治疗类风湿关节炎（RA）的当前应用模式。
我们对 2002 年至 2014 年间在 MD 安德森癌症中心初诊的患有 RA 和癌症的患者进行了回顾性队列研究。通过肿瘤登记处确定了癌症患者队列，通过 ICD-9 代码确定了 RA 患者，然后通过电子病历进行了回顾。我们纳入了年龄在 18 岁及以上、有癌症诊断和风湿病学家诊断的 RA 患者。患者随访至 2016 年。
我们确定了符合纳入标准的 431 名患有 RA 和癌症的患者。总体而言，有 111 名（26%）在癌症诊断后接受了 bDMARD 治疗；其中，有 60 名（54%）在癌症诊断前接受了 bDMARD 治疗，并在诊断后继续接受该治疗。有 13 名（22%）转为使用不同的 bDMARD，其余患者在癌症诊断后继续使用相同的药物。在所有接受 bDMARD 治疗的患者中，有 91 名（82%）接受了肿瘤坏死因子抑制剂（TNFi）治疗。
有癌症和 RA 病史的患者的治疗格局正在发生变化。需要进行未来的研究来评估最近有癌症病史或有活动性癌症的患者使用 bDMARD 的安全性。本项目的部分数据以海报形式在 2016 年美国风湿病学会年会上公布。Zamora NV、Siddhanamatha H、Barbo A、Tayar J、Lin H、Suarez-Almazor M。类风湿关节炎和癌症患者生物治疗的利用[摘要]。关节炎风湿病。2016; 68（增刊 10）。https://acrabstracts.org/abstract/utilization-of-biologic-therapy-in-patients-with-rheumatoid-arthritis-and-cancer/。访问日期：2019 年 9 月 30 日。关键点 • 我们机构的四分之一 RA 合并癌症患者在癌症诊断后接受了 bDMARDs 治疗，包括 TNFi。• 接受 bDMARD 治疗的 RA 和癌症患者中有一半在癌症诊断前开始治疗，并在此后继续治疗。
