The Risk for Second Cancer in RA Patients Treated with Biologics
An ACR report tried to analyze a common question among clinicians without a clear answer even to date: May a history of cancer contribute to the overall risk of cancer occurrence related to the prescription of biotherapies?
A Danish team made a welcome contribution to the debate with a work involving patients with rheumatoid arthritis (RA) and a history of cancer. Their goal was to identify a possible risk of second cancer and to document the mortality rates. Of the 1,678 patients involved, 502 received biologic therapy (190 only before first cancer diagnosis, 220 only after and 92 before and after) and 1,176 never received biologic therapy.
A non-significant increase in mortality
The analysis showed that among the 502 patients who received biotherapies, the risk of developing a second cancer is increased by an average of 11% compared to subjects who have never received biologic therapy, an increase that is not significant, however (HR 1.11, 95% CI 0.74-1.67).
Mortality data also indicated a higher probability of death for all patients who received biologic therapy, but again the increases were not significant compared to subjects who had not received biologic therapy.
The same observation is made when the analysis takes into account the prescription period
- HR 1.20 (95% CI 0.88-1.63) when administered only before the diagnosis of first cancer
- HR 1.36 (95% CI 0.78-2.39) when administered only after the diagnosis of first cancer.
- HR 1.22 (95% CI 0.70-2.13) when administered before and after the diagnosis of first cancer.
Overall, these data suggest that there is no reason to postpone a potentially useful treatment because of fear of occurrence of a second cancer, especially since this possible second cancer does not seem associated with a significant increase in the risk of cancer and death. The small number of patients who have developed a second cancer (n = 38) should nevertheless encourage a careful analysis of the results.
Reference
L Dreyer et al. Risk of Second Malignant Neoplasm and Mortality in Rheumatoid Arthritis Patients Treated with Biological Dmards: A Danish Population-Based Cohort Study. Abstract # 11L, ACR 2017, San Diego Nov 3-8
Tags: rheumatoid arthritis, biologics, drugs, cancer