Back
 JCT  Vol.6 No.8 , August 2015
Gastric Neoplasia during Anti-TNF Therapy for Crohn’s Disease: Casual Event?
F. M. L. Fortes1*, B. C. Silva2, B. C. Silva2, M. C. Lyra3, A. M. Pimentel1,3, G. O. Santana2,3
Show more
Abstract: The increase risk of cancer development in patients with inflammatory intestinal disease (IBD) has already studied for decades. The anti-TNF therapy has changed the treatment strategy of IBD. By using on a larger scale and for a longer time, the anti-TNF raised concern over its potential adverse events. A male Crohn’s disease (CD) patient, 55 years old, diagnosed for nine years, treated with infliximab for 6 years. In 2011, he underwent a nupper endoscopy (UE) which showed flat erosive gastritis with moderate intensity in antrum, gastric polyps and gastric erosion. Pathological examination revealed a chronic gastritis in erosive activity and search for Helicobacter pylori resulted positive. In May 2014, the patient was asymptomatic, when it held UE, which showed suggestive lesion of early gastric cancer, measuring 1.5 cm and search for Helicobacter pylori negative. Histopathological exams confirmed the adenocarcinoma. The patient underwent to a laparoscopic surgery (total gastrectomy with lymphadenectomy and reconstruction Roux-en-Y). Risk factors for the development of gastric cancer in general population are already well defined. However studying a possible association among CD and the different therapeutic modalities used in the treatment of this disease with gastric cancer appearance is important to set specific assessment strategies, prevention and follow-up. While there is no consensus on a proper monitoring for gastric cancer prevention in these patients, individualized conduct, taking into account individual characteristics, family record and other risk factors, should be adopted to avoid unfavorable outcomes in CD patients.
Keywords: Crohn’s Disease, Risk for Neoplasm, Gastric Neoplasm, Anti-TNF
Cite this paper: Fortes, F. , Silva, B. , Silva, B. , Lyra, M. , Pimentel, A. and Santana, G. (2015) Gastric Neoplasia during Anti-TNF Therapy for Crohn’s Disease: Casual Event?. Journal of Cancer Therapy, 6, 743-747. doi: 10.4236/jct.2015.68081.
References

[1]   Mizushima, T., Ohno, Y., Nakajima, K., Kai, Y., Iijima, H., Sekimoto, M., Nishida, T., et al. (2010) Malignancy in Crohn’s Disease: Incidence and Clinical Characteristics in Japan. Digestion, 81, 265-270.
http://dx.doi.org/10.1159/000273784

[2]   Song, Y., Zheng, P., Xiao, J. and Lu, Z. (2014) Efficacy and Safety of Adalimumab for the Crohn’s disease: A Systematic Review and Meta-Analysis of Published Randomized Placebo-Controlled Trials. European Journal of Clinical Pharmacology, 70, 907-914.
http://dx.doi.org/10.1007/s00228-014-1702-1

[3]   Mendes, D., Alves, C. and Batel-Marques, F. (2014) Safety Profiles of Adalimumab, Etanercept and Infliximab: A Pharmacovigilance Study Using a Measure of Disproportionality in a Database of Spontaneously Reported Adverse Events. Journal of Clinical Pharmacy and Therapeutics, 39, 307-313.
http://dx.doi.org/10.1111/jcpt.12148

[4]   Estlein, D., Ohana, G., Weil, R., Rath-Wolfson, L. and Wolloch, Y. (2001) Early Cancer in Gastric Crohn’s Disease. IMAJ, 3, 379-380.

[5]   Bernstein, C., Blanchard, J., Kliewer, E. and Wajda, A. (2001) Cancer Risk in Patients with Inflammatory Bowel Disease. Cancer, 91, 854-862.
http://dx.doi.org/10.1002/1097-0142(20010215)91:4<854::AID-CNCR1073>3.0.CO;2-Z

[6]   Hemminki, K., Li, X., Sundquist, J. and Sundquist, K. (2009) Cancer Risks in Crohn Disease Patients. Annals of Oncology, 20, 574-580.
http://dx.doi.org/10.1093/annonc/mdn595

[7]   Hudesman, D., Lichtiger, S. and Sands, B. (2013) Risk of Extraintestinal Solid Cancer with Anti-TNF Therapy in Adults with Inflammatory Bowel Disease: Review of the Literature. Inflammatory Bowel Diseases, 19, 644-649.
http://dx.doi.org/10.1097/MIB.0b013e318280ebbd

[8]   Persson, P.G., Karlén, P., Bernell, O., Leijonmarck, C.E., Brostrom, O., Ahlbom, A. and Hellers, G. (1994) Crohn’s Disease and Cancer: A Population-Based Cohort Study. Gastroenterology, 107, 1675-1679.

[9]   Andersen, N. and Jess, T. (2013) Has the Risk of Colorectal Cancer in Inflammatory Bowel Disease Decreased? World Journal of Gastroenterology, 19, 7561-7568.
http://dx.doi.org/10.3748/wjg.v19.i43.7561

[10]   Lutgens, M.W.M.D., Oijen, M.G.H., van der Heijden, G.J.M.G., Vleggaar, F.P., Siersema, P.D. and Oldenburg, B. (2013) Declining Risk of Colorectal Cancer in Inflammatory Bowel Disease: An Updated Meta-Analysis of Population-Based Cohort Studies. Inflammatory Bowel Diseases, 19, 789-799.
http://dx.doi.org/10.1097/MIB.0b013e31828029c0

[11]   Ikeuchi, H., Kusunoki, M., Yamamura, T. and Nishigami, T. (2002) Crohn’s Disease Associated with Gastric Cancer. Journal of Gastroenterology, 37, 47-49.
http://dx.doi.org/10.1007/s535-002-8132-6

[12]   Nam, J.H., Choi, J., Cho, S., Kim, C.G., Jun, J.K., Choi, K.S., et al. (2012) Association of the Interval between Endoscopies with Gastric Cancer Stage at Diagnosis in a Region of High Prevalence. Cancer, 118, 4953-4960.
http://dx.doi.org/10.1002/cncr.27495

[13]   Andersen, N.N., Pasternak, B., Basit, S., Andersson, M., Svanstrom, H., Caspersen, S., et al. (2014) Association between Tumor Necrosis Factor-α Antagonists and Risk of Cancer in Patients with Inflammatory Bowel Disease. JAMA, 311, 2406-2413.
http://dx.doi.org/10.1001/jama.2014.5613

 
 
Top