P0714 Low risk of recurrent or new neoplasia after immunomodulatory therapy in patients with Inflammatory Bowel Disease and previous cancer: a multicentre retrospective Italian study
Authors: Mancone R , Neri B , Bonacci L , Fiorillo M , Schiavone S C , Sparacino A , Testa A , Festa S , Marafini I , Orlando A , Castiglione F , Fries W , Calabrese E , Monteleone G , Biancone L 
Published: January 2025

Background

Whether using immunosuppressors (ISS) or biologics after a diagnosis of cancer in Inflammatory Bowel Disease (IBD) patients (pts) may increase the risk of new or recurrent cancer is undefined. Primary aim: to assess the frequency of new/recurrent cancer in IBD pts treated with ISS and/or biologics after a diagnosis of cancer. Secondary aims: to evaluate in the same population the cancer-related mortality and risk factors for recurrence or new malignancy.

Methods

In a retrospective multicentre Italian study, clinical records of all IBD pts treated with ISS or biologics after a diagnosis of cancer were reviewed. Inclusion criteria: 1)Diagnosis of Crohn’s Disease(CD) or Ulcerative Colitis(UC); 2)History of cancer; 3)Clinical outcome after cancer ≥6 months (mos). Exclusion criteria: 1)ISS/biologics used for ≤3 mos or ≤3 administrations; 2)missing data. Data expressed as median[range], differences assessed with Student t-test and X-square test, univariate analysis performed to search for risk factors for new or recurrent malignancy.

Results

Study population included 122 IBD pts(84 CD, 38 UC) treated with ISS/biologics after cancer (Female 58 [47.5%]; age: 59.5[26-89]yrs). Index cancer was: genitourinary in 18(14.8%), non-melanoma skin cancer (NMSC) in 17(13.9%), breast in 15(12.3%), thyroid in 13(10.6%), melanoma in 14(11.4%), colon in 11(9.0%), hematopoietic in 9(7.4%), prostate in 8(6.6%), head-neck and neuro-endocrine each in 4(3.3%), liver in 3(2.5%), other in 3(2.5%), lung in 1(0.8%). ISS used after cancer (duration: 29[4-200] mos) included: thiopurines in 10(37%), methotrexate in 14(51.9%), others in 3(11.1%) pts.Biologics used after cancer (duration: 24[3-180] mos) included: Anti-TNF in 36(32.4%), VDZ in 60(53.6%), UST in 45(40.2%), small molecules in 50(44.6%) and others in 6(5.4%) pts.The median time interval between cancer and ISS or biologics use was 27[0-312] and 48[1-432] mos, respectively. In a median follow up of 8[1-45] yrs after index cancer, 12(9.8%) IBD patients developed new or recurrent malignancy after ISS or biologics use. There were 6 recurrent neoplasms (2 prostatic, 2 thyroid,1 colon,1 melanoma) and 7 new malignancy (6 NMSC,1 Head-neck). No cancer-related death occurred. No differences were observed in terms of IBD phenotype and ISS/biologics treatments between patients with vs without new/recurrent malignancy. At univariate analysis, when considering age at malignancy, smoking habits, gender, IMM treatment and duration before and after index cancer and treatment for malignancy, no predictive factors for new/recurrent malignancy were observed.

Conclusion

A low frequency of new or recurrent cancer was observed using immunomodulators after cancer in IBD.No risk factors for new/recurrent malignancy were observed.

References

1. Gordon H. et al. ECCO Guidelines on IBD and Malignancies, Journal of Crohn’s and Colitis, 2023.