AB0295 CLINICAL CHARACTERISTICS OF 31 CASES OF MALIGNANT SOLID TUMORS IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: Akiko Aoki, Hiroshi Kobayashi, Hiroshi Oka
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> A recent meta-analysis shows patients with rheumatoid arthritis (RA) are at increased risk of lung and lymphoid malignancies compared with general populations<sup>1)</sup>. Rheumatologists perform cancer screening before treatment of biological disease-modifying anti-rheumatic drugs (DMARDs), and do routine blood, urine and imaging tests to find adverse effects of DMARDs. However, they can't always find malignant solid tumors (cancers) at the early stage in patients with RA. <h3>Objectives</h3> We examine characteristics of cancers in patients with RA and use the data to help diagnose the cancers in early stages during medical checkups. <h3>Methods</h3> In this retrospective study, we studied 397 patients with RA who visited our rheumatology clinic from April 2011 to December 2018. Thirty-one cancers in 29 patients with RA were reviewed. The onset of RA and cancer, the medication situation and prognosis were analyzed. <h3>Results</h3> Twenty-five were female, and 4 males. The mean age of diagnosis of RA and cancer were 55 years old (SD 15.0) and 66 (SD 11.4). The median duration of RA prior to cancer diagnosis was 8 years (IQR 4-18). The median follow-up was 4.3 years (range 0.2-7.8). One case of breast cancer was diagnosed with RA at the same time. Breast, Lung and Gastrointestinal cancers were the most common, followed by uterine cervix and skin. Two female patients had metachronous double cancers (uterine cervix and lung, skin and lung). Sex cancers; uterine cervix 3, breast 2, and anal melanoma 1, were found by cancer screening tests that the patients received voluntarily. Twelve cases were detected by blood tests or imaging tests performed in outpatient settings. Three lung cancers were found by the chest CT at the diagnosis of RA and before treatment of biological DMARDs, which were all at the early stage and cured by the resection. A gastric and a colon cancer, which were detected by worsening of microcytic anemia, were in advanced stage with hepatic metastases. Nineteen patients were treated with methotrexate (MTX) before detection of cancers. But only 4 patients continued MTX after detection of cancers. Six patients were treated with biological DMARDs (TNF inhibitor 3, tocilizumab 2, abatacept 1) before detection of cancers. Two patients were treated with TNF inhibitor until just before the admission for cancer treatment, because the rheumatologists did not notice their patients' cancers. After treatment of cancer, 3 patients were treated with tocilizumab and abatacept. The prognosis of 29 patients were as follows; death by cancers 4, death by pneumonia 2, undergoing chemotherapy 6, in remission 17. <h3>Conclusion</h3> The consultation rates for breast and cervix cancer screening are lower in Japan than in European nations. Rheumatologists should encourage their patients to have usual age and sex appropriate cancer screening. A large cohort study showed biological DMARDs did not increase risk of second malignant neoplasm among RA patients with a history of cancer<sup>2)</sup>. However, in this study, no patients were treated with TNF inhibitor after treatment of cancer. <h3>References</h3> [1] Simon TA, et al. Incidence of malignancy in adult patients with rheumatoid arthritis: meta-analysis. Arthritis Research and Therapy 2015; 17:212 [2] Dreyer L, et al. Risk of second malignant neoplasm and mortality in patients with rheumatoid arthritis treated with biological DMARDs: a Danish population-based cohort study. Ann Rheum Dis 2017; 0:1-5 <h3>Disclosure of Interests</h3> None declared