SNFGE SNFGE
 
Thématique :
- MICI
- Cancers autres (hors CCR et CHC)
- Cancer colorectal (CCR)
- Carcinome hépatocellulaire (CHC)
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Roger FAROUX
Coup de coeur :
 
 
Gastroenterology
  2016/07  
 
  2016 Jul;151(1):97-109.e4  
  doi: 10.1053/j.gastro.2016.03.037  
 
  Cancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis  
 
  Shelton E, Laharie D, Scott FI, Mamtani R, Lewis JD, Colombel JF, Ananthakrishnan AN  
  https://www.ncbi.nlm.nih.gov/pubmed/27039969  
 
 

BACKGROUND & AIMS:

Physicians frequently encounter patients with immune-mediated diseases and a history of malignancy. There are limited data on the safety of immunosuppressive therapy for these patients. Published studies have been small with few events, precluding robust estimates of risk.

METHODS:

We searched Medline, EMBASE, and conference proceedings for terms related to immune-mediated disease, immune-suppressive therapy, and cancer recurrence from inception to April 2015. We included 16 studies (9 of patients with rheumatoid arthritis, 8 of patients with inflammatory bowel disease, and 1 of patients with psoriasis) and stratified studies by type of immune-suppressive therapy (monoclonal antibodies to tumor necrosis factor [anti-TNF], conventional immune-modulatory agents, or no immune suppression). A random-effects meta-analysis was performed to calculate the pooled incidence rates as well as risk differences between the various treatments.

RESULTS:

Our analysis included 11,702 persons contributing 31,258 person-years (p-y) of follow-up evaluation after a prior diagnosis of cancer. Rates of cancer recurrence were similar among individuals receiving anti-TNF therapy (33.8 per 1000 p-y), immune-modulator therapy (36.2 per 1000 p-y), or no immunosuppression (37.5 per 1000 p-y), but were numerically higher among patients receiving combination immune suppression (54.5 per 1000 p-y) (P > .1 for all). Subgroup analysis of new and recurrent cancers separately, type of immune-modulator therapy, or immune-mediated disease showed similar results, with no increase in risk. We found similar pooled incidence values for new or primary cancers when immunosuppression was initiated within 6 years (33.6 per 1000 p-y for immune-modulatory agents and 43.7 per 1000 p-y for anti-TNF agents) vs more than 6 years after the index cancer (32.9 per 1000 p-y for immune-modulatory agents, P = .86; and 21.0 per 1000 p-y for anti-TNF agents, P = .43).

CONCLUSIONS:

In a meta-analysis of 16 studies, we observed similar rates of cancer recurrence among individuals with prior cancer who received no immunosuppression, anti-TNF therapy, immune-modulator therapy, or combination treatments. Prospective studies are needed to ascertain optimal intervals for re-initiation of immune-suppressive therapies for individuals with specific cancers.

 
Question posée
 
La prescription d’immunosuppresseurs dans les maladies inflammatoires et en particulier dans les MICI augmente-t-elle le risque de récidive néoplasique pour les patients aux antécédents de cancers ?
 
Question posée
 
Pas d’augmentation de l’incidence de nouveau cancer chez les patients avec antécédent préalable de cancer traités par anti TNFα, thopurines,méthotrexate ou traitement combiné par rapport à ceux ne recevant pas de traitement immunosuppresseur.
 
Commentaires

Méta-analyse qui apporte un élément rassurant supplémentaire à la prescription d’immunosuppresseurs après un cancer, rejoignant les recommandations de l’ECCO 2015. L’antécédent de mélanome reste cependant une contre-indication aux anti-TNFα.

 
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