Current Treatment Strategies for Inflammatory Bowel Disease Patients at the Risk of Developing Cancer: A Comprehensive Review

Abstract

Inflammatory bowel disease (IBD) is a chronic condition that affects the digestive tract and can lead to inflammation and damage to the intestinal lining. IBD patients with cancer encounter difficulties since cancer treatment weakens their immune systems. A multidisciplinary strategy that strikes a balance between the requirement to manage IBD symptoms and the potential effects of treatment on cancer is necessary for effective care of IBD in cancer patients. To reduce inflammation and avoid problems, IBD in cancer patients is often managed by closely monitoring IBD symptoms in conjunction with the necessary medication and surgical intervention. Anti-inflammatory medications, immunomodulators, and biologic therapies may be used for medical care, and surgical options may include resection of the diseased intestine or removal of the entire colon. The current study provides a paradigm for shared decision-making involving the patient, gastroenterologist, and oncologist while considering recent findings on the safety of IBD medicines, cancer, and recurrent cancer risk in individuals with IBD. We hope to summarize the pertinent research in this review and offer useful advice.

Keywords

Inflammatory bowel disorder - Cancer - treatment - malignancy - Anti-TNF - therapy - risks - inflammation - immunosuppression

Publikationsverlauf

Eingereicht: 30. April 2023

Angenommen: 21. Juni 2023

Artikel online veröffentlicht:
21. September 2023

• References

• 1 Kaser A, Zeissig S, Blumberg RS. Inflammatory bowel disease. Annu Rev Immunol 2010; 28: 573-621
• 2 Wang X, Xie L, Long J. et al. Therapeutic effect of baicalin on inflammatory bowel disease: A review. J Ethnopharmacol 2022; 283: 114749
• 3 Shivashankar R, Tremaine WJ, Harmsen WS, Loftus Jr EV. Incidence and prevalence of Crohn's disease and ulcerative colitis in Olmsted County, Minnesota from 1970 through 2010. Clin Gastroenterol Hepatol 2017; 15 (06) 857-863
• 4 Ahmad AS, Ormiston-Smith N, Sasieni PD. Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those born from 1930 to 1960. Br J Cancer 2015; 112 (05) 943-947
• 5 Porter RJ, Arends MJ, Churchhouse AMD, Din S. Inflammatory bowel disease-associated colorectal cancer: translational risks from mechanisms to medicines. J Crohn's Colitis 2021; 15 (12) 2131-2141
• 6 Beaugerie L, Carrat F, Nahon S. et al; Cancers et Surrisque Associé aux Maladies Inflammatoires Intestinales En France Study Group. High risk of anal and rectal cancer in patients with anal and/or perianal Crohn's disease. Clin Gastroenterol Hepatol 2018; 16 (06) 892-899.e2
• 7 Balkwill F. Tumour necrosis factor and cancer. Nat Rev Cancer 2009; 9 (05) 361-371
• 8 Monaco C, Nanchahal J, Taylor P, Feldmann M. Anti-TNF therapy: past, present and future. Int Immunol 2015; 27 (01) 55-62
• 9 Lemaitre M, Kirchgesner J, Rudnichi A. et al. Association between use of thiopurines or tumor necrosis factor antagonists alone or in combination and risk of lymphoma in patients with inflammatory bowel disease. JAMA 2017; 318 (17) 1679-1686
• 10 Dahmus J, Rosario M, Clarke K. Risk of lymphoma associated with anti-TNF therapy in patients with inflammatory bowel disease: implications for therapy. Clin Exp Gastroenterol 2020; 13: 339-350
• 11 Micic D, Komaki Y, Alavanja A, Rubin DT, Sakuraba A. Risk of cancer recurrence among individuals exposed to antitumor necrosis factor therapy: a systematic review and meta-analysis of observational studies. J Clin Gastroenterol 2019; 53 (01) e1-e11
• 12 Salliot C, van der Heijde D. Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research. Ann Rheum Dis 2009; 68 (07) 1100-1104
• 13 Annese V, Beaugerie L, Egan L. et al; ECCO. European evidence-based consensus: inflammatory bowel disease and malignancies. J Crohn's Colitis 2015; 9 (11) 945-965
• 14 Garcia-Neuer M, Marmarelis ME, Jangi SR. et al. Diagnostic comparison of CT scans and colonoscopy for immune-related colitis in ipilimumab-treated advanced melanoma patients. Cancer Immunol Res 2017; 5 (04) 286-291
• 15 Long MD, Martin CF, Pipkin CA, Herfarth HH, Sandler RS, Kappelman MD. Risk of melanoma and nonmelanoma skin cancer among patients with inflammatory bowel disease. Gastroenterology 2012; 143 (02) 390-399.e1
• 16 Zitvogel L, Tesniere A, Kroemer G. Cancer despite immunosurveillance: immunoselection and immunosubversion. Nat Rev Immunol 2006; 6 (10) 715-727
• 17 Münz C, Moormann A. Immune escape by Epstein-Barr virus associated malignancies. Semin Cancer Biol 2008; 18 (06) 381-387
• 18 Zheng KYC, Guo CG, Wong IOL. et al. Risk of malignancies in patients with inflammatory bowel disease who used thiopurines as compared with other indications: a territory-wide study. Therap Adv Gastroenterol 2020; 13: 1756284820967275
• 19 Armstrong RG, West J, Card TR. Risk of cancer in inflammatory bowel disease treated with azathioprine: a UK population-based case-control study. Am J Gastroenterol 2010; 105 (07) 1604-1609
• 20 O'Donovan P, Perrett CM, Zhang X. et al. Azathioprine and UVA light generate mutagenic oxidative DNA damage. Science 2005; 309 (5742) 1871-1874
• 21 Peyrin-Biroulet L, Khosrotehrani K, Carrat F. et al; Cesame Study Group. Increased risk for nonmelanoma skin cancers in patients who receive thiopurines for inflammatory bowel disease. Gastroenterology 2011; 141 (05) 1621-28.e1 , 5
• 22 Watermeyer G, Awuku Y, Fredericks E. et al; Gastroenterology and Hepatology Association of sub-Saharan Africa (GHASSA). Challenges in the management of inflammatory bowel disease in sub-Saharan Africa. Lancet Gastroenterol Hepatol 2022; 7 (10) 962-972
• 23 Harwood CA, Attard NR, O'Donovan P. et al. PTCH mutations in basal cell carcinomas from azathioprine-treated organ transplant recipients. Br J Cancer 2008; 99 (08) 1276-1284
• 24 Gutierrez-Dalmau A, Campistol JM. Immunosuppressive therapy and malignancy in organ transplant recipients: a systematic review. Drugs 2007; 67 (08) 1167-1198
• 25 Pasternak B, Svanström H, Schmiegelow K, Jess T, Hviid A. Use of azathioprine and the risk of cancer in inflammatory bowel disease. Am J Epidemiol 2013; 177 (11) 1296-1305
• 26 Nyboe Andersen N, Pasternak B, Basit S. et al. Association between tumor necrosis factor-α antagonists and risk of cancer in patients with inflammatory bowel disease. JAMA 2014; 311 (23) 2406-2413
• 27 Scharl S, Barthel C, Rossel JB. et al. Malignancies in inflammatory bowel disease: frequency, incidence and risk factors-results from the Swiss IBD Cohort Study. Am J Gastroenterol 2019; 114 (01) 116-126
• 28 Pascal V, Pozuelo M, Borruel N. et al. A microbial signature for Crohn's disease. Gut 2017; 66 (05) 813-822
• 29 Wong NA, Herbst H, Herrmann K. et al. Epstein-Barr virus infection in colorectal neoplasms associated with inflammatory bowel disease: detection of the virus in lymphomas but not in adenocarcinomas. J Pathol 2003; 201 (02) 312-318
• 30 Slesser AA, Bhangu A, Bower M, Goldin R, Tekkis PP. A systematic review of anal squamous cell carcinoma in inflammatory bowel disease. Surg Oncol 2013; 22 (04) 230-237
• 31 Kandiel A, Fraser AG, Korelitz BI, Brensinger C, Lewis JD. Increased risk of lymphoma among inflammatory bowel disease patients treated with azathioprine and 6-mercaptopurine. Gut 2005; 54 (08) 1121-1125
• 32 Ferlay J, Soerjomataram I, Dikshit R. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136 (05) E359-E386
• 33 Dulai PS, Thompson KD, Blunt HB, Dubinsky MC, Siegel CA. Risks of serious infection or lymphoma with anti-tumor necrosis factor therapy for pediatric inflammatory bowel disease: a systematic review. Clin Gastroenterol Hepatol 2014; 12 (09) 1443-1451 , quiz e88–e89
• 34 Ulman R. Treatment of Ulcerative colitis.
• 35 Azer SA. Overview of molecular pathways in inflammatory bowel disease associated with colorectal cancer development. Eur J Gastroenterol Hepatol 2013; 25 (03) 271-281
• 36 Triantafillidis JK, Nasioulas G, Kosmidis PA. Colorectal cancer and inflammatory bowel disease: epidemiology, risk factors, mechanisms of carcinogenesis and prevention strategies. Anticancer Res 2009; 29 (07) 2727-2737
• 37 Kulaylat MN, Dayton MT. Ulcerative colitis and cancer. J Surg Oncol 2010; 101 (08) 706-712
• 38 Befrits R, Hammarberg C, Rubio C, Jaramillo E, Tribukait B. DNA aneuploidy and histologic dysplasia in long-standing ulcerative colitis. A 10-year follow-up study. Dis Colon Rectum 1994; 37 (04) 313-319 , discussion 319–320
• 39 Willenbucher RF, Zelman SJ, Ferrell LD, Moore II DH, Waldman FM. Chromosomal alterations in ulcerative colitis-related neoplastic progression. Gastroenterology 1997; 113 (03) 791-801
• 40 Hardy RG, Meltzer SJ, Jankowski JA. ABC of colorectal cancer. Molecular basis for risk factors. BMJ 2000; 321 (7265) 886-889
• 41 Kraus S, Arber N. Inflammation and colorectal cancer. Curr Opin Pharmacol 2009; 9 (04) 405-410
• 42 Svrcek M, El-Bchiri J, Chalastanis A. et al. Specific clinical and biological features characterize inflammatory bowel disease associated colorectal cancers showing microsatellite instability. J Clin Oncol 2007; 25 (27) 4231-4238
• 43 Fleisher AS, Esteller M, Harpaz N. et al. Microsatellite instability in inflammatory bowel disease-associated neoplastic lesions is associated with hypermethylation and diminished expression of the DNA mismatch repair gene, hMLH1. Cancer Res 2000; 60 (17) 4864-4868
• 44 Nguyen GC, Smalley WE, Vege SS, Carrasco-Labra A. Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on the medical management of microscopic colitis. Gastroenterology 2016; 150 (01) 242-246 , quiz e17–e18
• 45 Elzagheid A, Emaetig F, Alkikhia L. et al. High cyclooxygenase-2 expression is associated with advanced stages in colorectal cancer. Anticancer Res 2013; 33 (08) 3137-3143
• 46 Olofsson K. Immunopathological aspects of equine inflammatory bowel disease. 2016
• 47 Hussain SP, Amstad P, Raja K. et al. Increased p53 mutation load in noncancerous colon tissue from ulcerative colitis: a cancer-prone chronic inflammatory disease. Cancer Res 2000; 60 (13) 3333-3337
• 48 Balish E, Warner T. Enterococcus faecalis induces inflammatory bowel disease in interleukin-10 knockout mice. Am J Pathol 2002; 160 (06) 2253-2257
• 49 Berg DJ, Davidson N, Kühn R. et al. Enterocolitis and colon cancer in interleukin-10-deficient mice are associated with aberrant cytokine production and CD4(+) TH1-like responses. J Clin Invest 1996; 98 (04) 1010-1020
• 50 O'Mahony L, Feeney M, O'Halloran S. et al. Probiotic impact on microbial flora, inflammation and tumour development in IL-10 knockout mice. Aliment Pharmacol Ther 2001; 15 (08) 1219-1225
• 51 Sattler L, Hanauer SB, Malter L. Immunomodulatory agents for treatment of patients with inflammatory bowel disease (review safety of anti-TNF, Anti-Integrin, anti-IL-12/23, JAK inhibition, sphingosine 1-phosphate receptor modulator, azathioprine / 6-MP and methotrexate). Curr Gastroenterol Rep 2021; 23 (12) 30
• 52 Shelton E, Laharie D, Scott FI. et al. Cancer recurrence following immune-suppressive therapies in patients with immune-mediated diseases: a systematic review and meta-analysis. Gastroenterology 2016; 151 (01) 97-109.e4
• 53 Lamb CA, Kennedy NA, Raine T. et al; IBD guidelines eDelphi consensus group. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019; 68 (Suppl. 03) s1-s106
• 54 Rajca S, Seksik P, Bourrier A. et al. Impact of the diagnosis and treatment of cancer on the course of inflammatory bowel disease. J Crohn's Colitis 2014; 8 (08) 819-824
• 55 Hussain SP, Harris CC. Inflammation and cancer: an ancient link with novel potentials. Int J Cancer 2007; 121 (11) 2373-2380
• 56 Axelrad JE, Fowler SA, Friedman S, Ananthakrishnan AN, Yajnik V. Effects of cancer treatment on inflammatory bowel disease remission and reactivation. Clin Gastroenterol Hepatol 2012; 10 (09) 1021-7.e1
• 57 Bernheim O, Colombel JF, Ullman TA, Laharie D, Beaugerie L, Itzkowitz SH. The management of immunosuppression in patients with inflammatory bowel disease and cancer. Gut 2013; 62 (11) 1523-1528
• 58 Khoury W, Lavery IC, Kiran RP. Effects of chronic immunosuppression on long-term oncologic outcomes for colorectal cancer patients undergoing surgery. Ann Surg 2011; 253 (02) 323-327
• 59 Jensen AØ, Thomsen HF, Engebjerg MC. et al. Use of oral glucocorticoids and risk of skin cancer and non-Hodgkin's lymphoma: a population-based case-control study. Br J Cancer 2009; 100 (01) 200-205
• 60 Sørensen GV, Cronin-Fenton DP, Sørensen HT, Ulrichsen SP, Pedersen L, Lash TL. Use of glucocorticoids and risk of breast cancer: a Danish population-based case-control study. Breast Cancer Res 2012; 14 (01) R21