2024年欧洲抗风湿病联盟关于炎性关节炎合并癌症病史患者开始使用靶向治疗的考虑要点

2024 EULAR points to consider on the initiation of targeted therapies in patients with inflammatory arthritis and a history of cancer.

作者信息

Sebbag Eden, Lauper Kim, Molina-Collada Juan, Aletaha Daniel, Askling Johan, Gente Karolina, Bertheussen Heidi, Bitoun Samuel, Bolek Ertugrul Cagri, Burmester Gerd R, Canhão Helena M, Chatzidionysiou Katerina, Curtis Jeffrey R, Danlos Francois-Xavier, Guimarães Vera, Hetland Merete Lund, Iannone Florenzo, Kostine Marie, Kragstrup Tue Wenzel, Kvien Tore K, Regierer Anne Constanze, Schulze-Koops Hendrik, Silva-Fernández Lucía, Szekanecz Zoltan, Buch Maya H, Finckh Axel, Gottenberg Jacques-Eric

机构信息

Department of Rheumatology, Centre National de Référence des Maladies Auto-Immunes Rares, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.

Division of Rheumatology & Geneva Centre for Inflammation research/ Department of Medicine, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Genève, Switzerland.

出版信息

Ann Rheum Dis. 2024 Dec 20. doi: 10.1136/ard-2024-225982.

DOI:10.1136/ard-2024-225982

PMID:39739385

Abstract

BACKGROUND

Potential associations between targeted therapies and a new cancer in patients with inflammatory arthritis (IA) and a previous malignancy are a frequent concern in daily rheumatology practice.

OBJECTIVES

To develop points to consider (PTC) to assist rheumatologists when initiating a targeted therapy in the context of a previous malignancy.

METHODS

Following EULAR standardised operating procedures, a task force met to define the research questions for a systematic literature review and to formulate the overarching principles (OPs) and the PTC.

RESULTS

The group formulated five OPs; seven PTC were formulated concerning the initiation of targeted therapies in patients with active IA and a previous malignancy in remission and one PTC concerning patients with active IA who were not in cancer remission. Major themes included (a) the need to assess the individualised risk of cancer recurrence based on the characteristics of the patient, cancer and the underlying disease; (b) the importance of engaging with specialists caring for cancer and defining treatment based on a shared decision between the patient and the rheumatologist; (c) the value of initiating without delay an appropriate targeted therapy for the treatment of the IA in patients in remission of their cancer; (d) the proposal to use Janus kinase inhibitors and abatacept with caution and in the absence of therapeutic alternatives, based on the absence of any data concerning their use in the context of previous malignancy.

CONCLUSION

The 2024 EULAR points to consider provide guidance on the management of targeted therapies in patients with IA and a previous malignancy.

摘要

背景

在日常风湿病学实践中，靶向治疗与炎性关节炎（IA）患者新发癌症以及既往恶性肿瘤之间的潜在关联是一个常见的关注点。

目的

制定要点考量（PTC），以协助风湿病学家在既往有恶性肿瘤的情况下启动靶向治疗。

方法

按照欧洲抗风湿病联盟（EULAR）标准化操作程序，一个特别工作组开会确定系统文献综述的研究问题，并制定总体原则（OP）和要点考量（PTC）。

结果

该小组制定了五项总体原则；针对活动性IA且既往恶性肿瘤已缓解的患者启动靶向治疗制定了七项要点考量，针对癌症未缓解的活动性IA患者制定了一项要点考量。主要主题包括：（a）需要根据患者、癌症及基础疾病的特征评估癌症复发的个体化风险；（b）与负责癌症治疗的专科医生合作并基于患者与风湿病学家共同决策确定治疗方案的重要性；（c）对于癌症已缓解的患者，应立即启动适当的靶向治疗来治疗IA；（d）鉴于缺乏关于在既往有恶性肿瘤情况下使用的任何数据，建议谨慎使用Janus激酶抑制剂和阿巴西普，且仅在没有其他治疗选择时使用。