JCT  Vol.4 No.3 A , March 2013
Biological Therapy and Risk of Malignancies: A Literature Review
ABSTRACT
Data from literature show that the overall risk of cancer does not as a result from treatment with these drugs. The only cancer for which various authors have reported an increased risk, in some cases, are skin cancers, different from melanoma and melanoma. Recent results of large observational studies and meta-analyzes indicate the absence of an increased risk of lymphoma related to therapy with anti-TNF-α. It has been reported, by some authors, that there is a possible increased risk of lung cancer, especially in patients with chronic obstructive pulmonary disease. There is limited information in literature about the effects of biologics in patients with a history of cancer. Most of the guidelines indicate that treatment with biologics can be considered with caution and only in patients free of cancer since at least 5 years. Some studies report a lower oncological risk with etanercept compared to monoclonal antibodies, especially in the case of lymphoma. However, this data has not been confirmed in other studies, and has been associated with a limited period of time after starting therapy. Information about the latest biological therapies is still poor. Therefore, there is not sufficient evidence for a preferential use of certain drugs rather than others.

Cite this paper
G. Sandri, V. Cestelli and M. Mascia, "Biological Therapy and Risk of Malignancies: A Literature Review," Journal of Cancer Therapy, Vol. 4 No. 3, 2013, pp. 460-465. doi: 10.4236/jct.2013.43A056.
References
[1]   L. Abásolo, E. Júdez, M. A. Descalzo, et al. and EME-CAR Study Group, “Cancer in Rheumatoid Arthritis: Occurrence, Mortality, and Associated Factors in a South European Population,” Seminars in Arthritis and Rheumatism, Vol. 37, No. 6, 2008, pp. 388-397. doi:10.1016/j.semarthrit.2007.08.006

[2]   J. Askling, C. M. Fored, E. Baecklund, et al., “Haematopoietic Malignancies in Rheumatoid Arthritis: Lymphoma Risk and Characteristics after Exposure to Tumor Necrosis Factor Antagonists,” Annals of the Rheumatic Diseases, Vol. 64, No. 10, 2005, pp. 1414-1420. doi:10.1136/ard.2004.033241

[3]   J. Askling, C. M. Fored, L. Brandt, et al., “Risks of Solid Cancers in Patients with Rheumatoid Arthritis and after Treatment with Tumor Necrosis Factor Antagonists,” Annals of the Rheumatic Diseases, Vol. 64, No. 10, 2005, pp. 1421-1426. doi:10.1136/ard.2004.033993

[4]   F. Wolfe and K. Michaud, “Biologic Treatment of Rheumatoid Arthritis and the Risk of Malignancy: Analyses from a Large US Observational Study,” Arthritis & Rheumatism, Vol. 56, No. 9, 2007, pp. 2886-2895. doi:10.1002/art.22864

[5]   K. Hemminki, X. Li, K. Sundquist and J. Sundquist, “Cancer Risk in Hospitalized Rheumatoid Arthritis Patients,” Rheumatology (Oxford), Vol. 47, No. 5, 2008, pp. 698-701. doi:10.1093/rheumatology/ ken130

[6]   E. Thomas, D. H. Brewster, R. J. Black and G. J. Macfarlane, “Risk of Malignancy among Patients with Rheumatic Conditions,” International Journal of Cancer, Vol. 88, No. 3, 2000, pp. 497-502. doi:10.1002/1097-0215(20001101)88:3<497::AID-IJC27>3.0.CO;2-J

[7]   R. Khurana, R. Wolf, S. Berney, et al., “Risk of Development of Lung Cancer Is Increased in Patients with Rheumatoid Arthritis: A Large Case Control Study in US Veterans,” Journal of Rheumatology, Vol. 35, 2008, pp. 1704-1708.

[8]   A. L. Smitten, T. A. Simon, M. C. Hochberg and S. Suissa, “A Meta-Analysis of the Incidence of Malignancy in Adult Patients with Rheumatoid Arthritis,” Arthritis Research & Therapy, Vol. 10, No. 2, 2008, p. R45. doi:10.1186/ar2404

[9]   J. Askling, R. F. van Vollenhoven, F. Granath, et al., “Cancer Risk in Patients with Rheumatoid Arthritis Treated with Anti-Tumor Necrosis Factor Alpha Therapies: Does the Risk Change with the Time Since Start of Treatment?” Arthritis & Rheumatism, Vol. 60, No. 11, 2009, pp. 3180-3189. doi:10.1002/art.24941

[10]   W. G. Dixon, K. D. Watson, M. Lunt, et al., British Society for Rheumatology Biologics Register Control Centre Consortium, British Society for Rheumatology Biologics Register, “Influence of Anti-Tumor Necrosis Factor Therapy on Cancer Incidence in Patients with Rheumatoid Arthritis Who Have Had a Prior Malignancy: Results from the British Society for Rheumatology Biologics Register,” Arthritis Care & Research, Vol. 62, No. 6, 2010, pp. 755-763. doi:10.1002/acr.20129

[11]   L. Carmona, L. Abasolo, M. A. Descalzo, et al., BIO-BADASER Study Group, EMECAR Study Group, “Cancer in Patients with Rheumatic Diseases Exposed to TNF Antagonists,” Seminars in Arthritis and Rheumatism, Vol. 41, No. 1, 2011, pp. 71-80. doi:10.1016/j.semarthrit.2010.08.005

[12]   F. B. Pallavicini, R. Caporali, P. Sarzi-Puttini, et al., “Tumor Necrosis Factor Antagonist Therapy and Cancer Development: Analysis of the LORHEN Registry,” Auto-immunity Reviews, Vol. 9, No. 3, 2010, pp. 175-180. doi:10.1016/j.autrev.2009.07.006

[13]   A. Strangfeld, F. Hierse, R. Rau, et al., “Risk of Incident or Recurrent Malignancies among Patients with Rheumatoid Arthritis Exposed to Biologic Therapy in the German Biologics Register RABBIT,” Arthritis Research & Therapy, Vol. 12, No. 1, 2010, p. R5. doi:10.1186/ar2904

[14]   P. Geborek, A. Bladstr?m, C. Turesson, et al., “Tumor Necrosis Factor Blockers Do not Increase Overall Tumour Risk in Patients with Rheumatoid Arthritis, but May Be Associated with an Increased Risk of Lymphomas,” Annals of the Rheumatic Diseases, Vol. 64, No. 5, 2005, pp. 699-703. doi:10.1136/ard.2004.030528

[15]   S. Setoguchi, D. H. Solomon, M. E. Weinblatt, et al., “Tumor Necrosis Factor Alpha Antagonist Use and Cancer in Patients with Rheumatoid Arthritis,” Arthritis & Rheumatism, Vol. 54, No. 9, 2006, pp. 2757-2764. doi:10.1002/art.22056

[16]   G. R. Burmester, P. Mease, B. A. Dijkmans, et al., “Adalimumab Safety and Mortality Rates from Global Clinical Trials of Six Immune-Mediated Inflammatory Diseases,” Annals of the Rheumatic Diseases, Vol. 68, 2009, pp. 1863-1869. doi:10.1136/ard.2008.102103

[17]   A. E. Thompson, S. W. Rieder and J. E. Pope, “Tumor Necrosis Factor Therapy and the Risk of Serious Infection and Malignancy in Patients with Early Rheumatoid Arthritis: A Meta-Analysis of Randomized Controlled Trials,” Arthritis & Rheumatism, Vol. 63, No. 6, 2011, pp. 1479-1485. doi:10.1002/art.30310

[18]   T. Bongartz, A. J. Sutton, M. J. Sweeting, et al., “Anti-TNF Antibody Therapy in Rheumatoid Arthritis and the Risk of Serious Infections and Malignancies: Systematic Review and Meta-Analysis of Rare Harmful Effects in Randomized Controlled Trials,” Journal of American Medical Association (JAMA), Vol. 295, No. 19, 2006, pp. 2275-2285. doi:10.1001/jama.295.19.2275

[19]   W. Dixon and A. Silman, “Is There an Association between Anti-TNF Monoclonal Antibody Therapy in Rheumatoid Arthritis and Risk of Malignancy and Serious Infection? Commentary on the Meta-Analysis by Bongartz et al.,” Arthritis Research & Therapy, Vol. 8, No. 5, 2006, p. 111. doi:10.1186/ar2026

[20]   T. Bongartz, F. C. Warren, D. Mines, et al., “Etanercept Therapy in Rheumatoid Arthritis and the Risk of Malignancies: A Systematic Review and Individual Patient Data Meta-Analysis of Randomized Controlled Trials,” Annals of the Rheumatic Diseases, Vol. 68, No. 7, 2009, pp. 1177-1183. doi:10.1136/ard.2008.094904

[21]   X. Mariette, M. Matucci-Cerinic, K. Pavelka, et al., “Malignancies Associated with Tumour Necrosis Factor Inhibitors in Registries and Prospective Observational Studies: A Systematic Review and Meta-Analysis,” Annals of the Rheumatic Diseases, Vol. 70, No. 11, 2011, pp. 1895-1904. doi:10.1136/ard.2010.149419

[22]   P. Raaschou, J. F. Simard, M. Neovius and J. Askling, “Anti-Rheumatic Therapy in Sweden Study Group. Does Cancer That Occurs during or after Anti-Tumor Necrosis Factor Therapy Have a Worse Prognosis? A National Assessment of Overall and Site-Specific Cancer Survival in Rheumatoid Arthritis Patients Treated with Biologic Agents,” Arthritis & Rheumatism, Vol. 63, No. 7, 2011, pp. 1812-1822. doi:10.1002/art.30247

[23]   F. Wolfe and K. Michaud, “The Effect of Methotrexate and Anti-Tumor Necrosis Factor Therapy on the Risk of Lymphoma in Rheumatoid Arthritis in 19,562 Patients during 89,710 Person-Years of Observation,” Arthritis & Rheumatism, Vol. 56, No. 6, 2007, pp. 1433-1439. doi:10.1002/art.22579

[24]   J. Askling, E. Baecklund, F. Granath, et al., “Anti-Tumor Necrosis Factor Therapy in Rheumatoid Arthritis and Risk of Malignant Lymphomas: Relative Risks and Time Trends in the Swedish Biologics Register,” Annals of the Rheumatic Diseases, Vol. 68, No. 5, 2009, pp. 648-653. doi:10.1136/ard.2007.085852

[25]   X. Mariette, F. Tubach, H. Bagheri, et al., “Lymphoma in Patients Treated with Anti-TNF: Results of the 3-Year Prospective French RATIO Registry,” Annals of the Rheumatic Diseases, Vol. 69, No. 2, 2010, pp. 400-408. doi:10.1136/ard.2009.117762

[26]   J. Askling, K. Fahrbach, B. Nordstrom, et al., “Cancer Risk with Tumor Necrosis Factor Alpha (TNF) Inhibitors: Meta-Analysis of Randomized Controlled Trials of Adalimumab, Etanercept, and Infliximab Using Patient Level Data,” Pharmacoepidemiol Drug Safety, Vol. 20, No. 2, 2011, pp. 119-130. doi:10.1002/pds.2046

[27]   S. I. Rennard, C. Fogarty, S. Kelsen, et al., “COPD Investigators. The Safety and Efficacy of Infliximab in Moderate to Severe Chronic Obstructive Pulmonary Disease,” American Journal of Respiratory and Critical Care Medicine, Vol. 175, No. 9, 2007, pp. 926-934. doi:10.1164/rccm.200607-995OC

[28]   M. H. Buch, J. S. Smolen, N. Betteridge, et al., “Rituximab Consensus Expert Committee. Updated Consensus Statement on the Use of Rituximab in Patients with Rheumatoid Arthritis,” Annals of the Rheumatic Diseases, Vol. 70, No. 6, 2011, pp. 909-920. doi:10.1136/ard.2010.144998

[29]   S. Slimani, L. Cédric, B. Combe and J. Morel, “Rituximab in Rheumatoid Arthritis and the Risk of Malignancies: Report from a French Cohort,” Joint Bone Spine, Vol. 78, No. 5, 2011, pp. 484-487. doi:10.1016/j.jbspin.2010.11.012

[30]   R. van Vollenhoven, P. Emery, C. Bingham, et al., “Extended Follow-Up of the Long-Term Safety of Rituximab in Rheumatoid Arthritis,” Annals of the Rheumatic Diseases, Vol. 66, 2007, p. 88

[31]   T. A. Simon, A. L. Smitten, J. Franklin, et al., “Malignancies in the Rheumatoid Arthritis Abatacept Clinical Development Programme: An Epidemiological Assessment,” Annals of the Rheumatic Diseases, Vol. 68, No. 12, 2009, pp. 1819-1826. doi:10.1136/ard.2008.097527

[32]   T. Koike, M. Harigai, S. Inokuma, et al., “Post Marketing Surveillance of Tocilizumab for Rheumatoid Arthritis in Japan: Interim Analysis of 3881 Patients,” Annals of the Rheumatic Diseases, Vol. 70, No. 12, 2011, pp. 2148-2151. doi:10.1136/ard.2011.151092

[33]   E. Baecklund, A. Iliadou, J. Askling, et al., “Association of Chronic Inflammation, Not Its Treatment, with Increased Lymphoma Risk in Rheumatoid Arthritis,” Arthritis & Rheumatism, Vol. 54, No. 3, 2006, pp. 692-701. doi:10.1002/art.21675

[34]   K. Hellgren, K. E. Smedby, N. Feltelius, et al., “Do Rheumatoid Arthritis and Lymphoma Share Risk Factors? A Comparison of Lymphoma and Cancer Risks before and after Diagnosis of Rheumatoid Arthritis,” Arthritis & Rheumatism, Vol. 62, No. 5, 2010, pp. 1252-1258. doi:10.1002/art.27402

[35]   X. Mariette, “Lymphoma, Rheumatoid Arthritis, and TNF-Alpha Antagonists,” Joint Bone Spine, Vol. 77, No. 3, 2010, pp. 195-197. doi:10.1016/j.jbspin.2010.02.002

 
 
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