rss
Gut 62:1523-1528 doi:10.1136/gutjnl-2013-305300
  • Leading article

The management of immunosuppression in patients with inflammatory bowel disease and cancer

  1. Steven H Itzkowitz1
  1. 1 The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2 Service d'Hepato-Gastroenterologie, CHU de Bordeaux, Hopital Haut-Leveque, Bordeaux, France
  3. 3 Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, Paris, France
  1. Correspondence to Professor J-F Colombel, The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1069, New York, NY 10029, USA; jean-frederic.colombel{at}mssm.edu
  • Received 25 June 2013
  • Revised 15 July 2013
  • Accepted 16 July 2013
  • Published Online First 31 July 2013

Introduction

Inflammatory bowel diseases (IBD) are chronic inflammatory conditions of the gastrointestinal tract. Immunomodulators and biologic agents (hereafter referred to jointly as ‘immunosuppression’) are effective in treating IBD and recent evidence supports their introduction earlier in the disease course.1 ,2 An important concern to both patients and physicians considering immunosuppression for the treatment of IBD is the potential associated cancer risk.

It is estimated that 1.6 million new diagnoses of cancer will be made in 2013 among the general population in the USA alone.3 Likewise, as the population of patients with IBD ages, it is inevitable that some will develop cancer. As such, in addition to concerns about the development of de novo cancer in a patient without a history of cancer, clinicians caring for patients with IBD are increasingly challenged with questions about IBD management after the development of cancer. Conversely, oncologists are often concerned about how to manage IBD in cancer patients.

Several important clinical questions deserve further attention with respect to IBD therapy and cancer (figure 1). First, does medical therapy for IBD predispose to developing cancer? Second, in an IBD patient with a history of cancer, does IBD therapy impact cancer recurrence? Third, once cancer develops in an IBD patient, is the cancer outcome different? Finally, in an IBD patient with current cancer, does the cancer therapy affect IBD outcomes?

Figure 1

Clinical questions related to patients with inflammatory bowel disease and cancer. IBD, inflammatory bowel disease; TNF, tumour necrosis factor.

Question 1, dealing with the topic of de novo cancer development related to treatments for IBD in patients without a history of cancer, has recently been reviewed.4 Less is known about the impact of immunosuppressive therapies on cancer in IBD patients who have had a prior (controlled) cancer or have a current (uncontrolled) cancer. …