Kimmel Jessica, Axelrad Jordan
Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center at New York University Langone Health, New York University School of Medicine, New York, NY, USA.
Curr Gastroenterol Rep. 2020 Feb 13;22(3):13. doi: 10.1007/s11894-020-0747-9.
Both the chronic inflammation in inflammatory bowel disease (IBD), and its treatment, can increase the risk of malignancy. There is also an increasing number of patients with current and prior cancer who require IBD treatment. Thus, there is a complex interplay between immunosuppressive treatment and monitoring for new and recurrent cancer.
Vedolizumab and ustekinumab have not been shown to increase the risk of malignancy. Transplant data shows a potential risk with tofacitinib although rheumatoid arthritis data does not. IBD patients have been shown to tolerate chemotherapy, specifically with cytotoxic compared with hormonal chemotherapy. Patients with prior cancer are at increased risk of new or recurrent cancers; however, immunosuppression appears to be safe. Emerging treatments for IBD have demonstrated acceptable safety profiles for malignancy risk, and immunosuppression appears to be safe for use in patients with current and prior malignancy. More data is still needed to assess long-term risk of malignancy in these patients, especially with newer treatments.
炎症性肠病（IBD）中的慢性炎症及其治疗均会增加恶性肿瘤风险。此外，有越来越多目前患有癌症或既往患过癌症的患者需要接受IBD治疗。因此，免疫抑制治疗与监测新发和复发性癌症之间存在复杂的相互作用。
维多珠单抗和乌司奴单抗尚未显示会增加恶性肿瘤风险。移植数据显示托法替布存在潜在风险，不过类风湿关节炎的数据并未显示此风险。已证明IBD患者能够耐受化疗，尤其是与激素化疗相比，细胞毒性化疗时更是如此。既往患过癌症的患者发生新发或复发性癌症的风险增加；然而，免疫抑制似乎是安全的。IBD的新兴治疗方法已显示出在恶性肿瘤风险方面可接受的安全性，免疫抑制似乎对目前患有恶性肿瘤和既往患过恶性肿瘤的患者使用是安全的。仍需要更多数据来评估这些患者发生恶性肿瘤的长期风险，尤其是使用更新治疗方法时的风险。
