What types of cancer treatment increase risk of IBD relapse?
Hormone therapy for cancer might increase the risk of IBD relapse. Enhanced monitoring of IBD should be considered in this setting.
Axelrad JE, Bazarbashi A, Zhou J, et al. Hormone Therapy for Cancer Is a Risk Factor for Relapse of Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2020;18(4):872–80.e1; https://doi.org/10.1016/j.cgh.2019.06.042
Researchers at five academic medical centers retrospectively examined data from 447 consecutive patients with IBD treated for a subsequent diagnosis of cancer between 1997 and 2018. Forty-four percent had Crohn’s disease, 53% had ulcerative colitis and 3% had unclassified IBD. Additionally, 78% had breast cancer and the remainder had prostate cancer. Approximately 90% of patients had inactive IBD at the time of cancer diagnosis. Most patients were white and female, patients were an average of 58 years of age at the time of cancer diagnosis, and the median duration of IBD prior to cancer diagnosis was 20 years.
Data showed that 28% of patients with inactive IBD at the time of cancer diagnosis experienced a relapse of IBD within a median of 99 months, while 30% of those with active IBD at cancer diagnosis achieved remission within a median 54 months after cancer diagnosis.
Seventy-five percent of patients who received cytotoxic chemotherapy alone, and had inactive IBD at cancer diagnosis, maintained remission at a median of 250 months, compared with 42% who received hormone monotherapy. Univariate analyses confirmed an association between hormone monotherapy and IBD relapse (Hazard Ratio [HR], 2.00; 95% Confidence Interval [CI], 1.21–3.29). Similarly, patients with quiescent IBD who received combination cytotoxic and hormone therapy were 1.86 times more likely than those not receiving the combination to experience IBD relapse (HR, 1.86; 95% CI, 1.01–3.43). Other factors associated with an increased risk of IBD relapse after a cancer diagnosis among those with quiescent IBD included prior use of corticosteroids (HR, 1.79; 95% CI, 1.18–2.71), immunomodulators (HR, 2.22; 95% CI, 1.38–3.55), or biologics (HR, 1.95; 95% CI, 1.01–5.36). With the exception of corticosteroid use, all of these risk factors maintained significance in multivariate analysis. There were no significant predictors of IBD remission among those with active IBD at the time of cancer diagnosis.
Study Design: Retrospective cohort analysis
Funding: Supported in part by a grant from The Chemotherapy Foundation
Allocation: Not applicable
Level of Evidence: 2b (Oxford Levels of Evidence)
The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.