Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.
Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, University of Copenhagen, Hvidovre Hospital, Hvidovre, Denmark.
J Crohns Colitis. 2023 Jul 5;17(7):1139-1153. doi: 10.1093/ecco-jcc/jjad010.
The association between cancer treatments and exacerbation of inflammatory bowel diseases [IBD] is unclear. We aimed to evaluate the effects of cancer treatments on the disease activity of IBD.
We performed a systematic review of the literature on cancer therapy in patients with pre-existing IBD. Electronic searches of PubMed, Cochrane Library and Embase were combined with manual searches (September 2021). Meta-analysis was performed using the random-effects model. The primary outcome was flares of IBD following cancer therapy. Secondary outcomes were need for IBD-related hospitalization, surgery, and initiation or intensification of steroid or biological treatments to manage IBD flares.
In total, 33 studies were included in the systematic review, comprising 1298 patients with IBD who received cancer treatment. The overall occurrence of IBD flares following cancer treatment was 30% (95% confidence interval [CI] 23-37%). IBD flares resulted in utilization of systemic steroids and biologic therapies among 25% and 10% of patients, respectively, and in discontinuation of cancer treatment among 14% of patients. Finally, the risk of gastrointestinal toxicity following immune check point inhibitor treatment [ICI] was increased in patients with IBD compared to patients without IBD (RR = 3.62 [95% CI 2.57-5.09]). Despite this, the studies generally reported that flares were manageable.
Current data indicate a high proportion of patients with IBD experiencing a flare following the start of cancer treatment. Patients with IBD were at an increased risk of gastrointestinal toxicity following ICI treatment compared to those without IBD. However, cancer therapy-induced IBD flares were manageable and should not preclude appropriate cancer treatments.
癌症治疗与炎症性肠病（IBD）恶化之间的关联尚不清楚。我们旨在评估癌症治疗对 IBD 疾病活动的影响。
我们对患有预先存在的 IBD 的患者进行了癌症治疗的文献进行了系统评价。电子搜索了 PubMed、Cochrane Library 和 Embase，并进行了手动搜索（2021 年 9 月）。使用随机效应模型进行荟萃分析。主要结局是癌症治疗后 IBD 的发作。次要结局是需要 IBD 相关住院治疗、手术以及启动或强化类固醇或生物治疗以治疗 IBD 发作。
共纳入了 33 项系统评价研究，其中包括 1298 名接受癌症治疗的 IBD 患者。癌症治疗后 IBD 发作的总体发生率为 30%（95%置信区间 [CI] 23-37%）。IBD 发作导致 25%和 10%的患者分别使用全身类固醇和生物疗法，14%的患者停止癌症治疗。最后，与无 IBD 的患者相比，IBD 患者接受免疫检查点抑制剂治疗 [ICI] 后发生胃肠道毒性的风险增加（RR = 3.62 [95%CI 2.57-5.09]）。尽管如此，这些研究通常报告说发作是可以控制的。
目前的数据表明，相当一部分 IBD 患者在开始癌症治疗后会出现发作。与无 IBD 的患者相比，IBD 患者接受 ICI 治疗后发生胃肠道毒性的风险增加。然而，癌症治疗引起的 IBD 发作是可以控制的，不应排除适当的癌症治疗。
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