CANCER OCURRENCE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN TREATMENT WITH ANTI-TNF

In this paper will be presented the cases of three patients with inflammatory bowel disease that have been treated with biological therapy with Infliximab and Adalimumab, having developed, respectively, non-Hodgkin lymphoma, colorectal carcinoma and cholangiocarcinoma after the long-term use of these medications; with that, we sought to demonstrate cases of neoplasia developed because of the long-term use of anti-TNF. TNF-alfa presents a fundamental role in the immune response, having been associated with carcinogenesis, when supressed, or with the contribution to inflammatory diseases, when dysfunctional. Inflammatory bowel disease has been pointed as an isolated risk factor for the development of lymphoma, biliary ducts cancer and intestinal cancer. With anti-TNF treatment, this risk changes in each specific case of neoplasia. This drug acts primarily in the mucosa repair, and the response to treatment can get to 69% of the patients with Chrons disease and to 70% of the patients with ulcerative rectocolitis in continuous treatment with Infliximab. To this moment, long-term use consequences have been pointed, such as the occurrence of opportunistic infections, tuberculosis, reactions to infusion and malignancies. Irregular data are found surrounding the malignancies, not being completely elucidated. Multiple neoplasias could be found, being mainly lymphomas and solid tumours of the digestive tract among the most commonly found. About the development of lymphoma, it has no significative alterations when in isolated treatment with anti-TNF, but with an increased relative risk when in combined therapy with immunomodulators of 4.4 (95% CI: 3.4-5.4). Although cases of tumour development exist, Biancone et al followed up 404 patients with IBD in treatment with Infliximab through a period of 5 years, and found no increase in malignancies when compared to the control group. Similar results were found with Lichtenstein et al in a study with 6273 patients. Some studies have demonstrated, in patients treated with Infliximab, a relative increase in the presentation of other inflammatory diseases, such as Wegener's granulomatosis and rheumatoid arthritis, also demonstrating the presentation of colorectal adenocarcinoma and cholangiocarcinoma. This study presents the cases of three patients with inflammatory bowel disease, having been treated with biological therapy, and that in any given moment have developed neoplasias.

Publication History

Article published online:
23 October 2019