PracticeUpdate: Dermatology & Rheumatology

AMERICAN COLLEGE OF RHEUMATOLOGY 2016 ANNUAL MEETING 26

12% of patient cohort with RA received biologic therapy after cancer diagnosis Twelve percent of a cohort of patients with rheumatoid arthritis either continued with a biologic agent or began a new biologic, most frequently a tumour necrosis factor inhibitor, reports a retrospective cohort study. N atalia V. Zamora, MD, of the University of Texas MD Anderson Cancer Center, Houston, explained that biologic therapy for rheumatoid arthritis Descriptive statistics were generated to summarise patient characteristics, biologic use, and time to biologic therapy onset after cancer diagnosis. Kaplan-Meier methods were used to estimate time from biologic therapy onset to recurrence.

downregulates the immune response. Tumoural immunity is an important host mechanism against cancer progression, and for this reason, biologic therapy is often discontinued when a patient with rheumatoid arthritis develops cancer. Dr Zamora said, “One of the biggest controversies in rheumatology is whether to stop or to continue a biologic agent amid certain conditions, such as cancer. At MD Anderson Cancer Center Hospital, we see a large number of patients with both conditions.” Dr Zamora and colleagues set out to determine the extent of utilisation of biologic therapy in patients with rheumatoid arthritis after a cancer diagnosis. Study patients with rheumatoid arthritis and cancer were seen at a National Cancer Institute Comprehensive Cancer Center between 2002 and 2014. Patients were initially identified as having rheumatoid arthritis if they submitted an insurance claim with a diagnostic code for rheumatoid arthritis (714) according to the International Classification of Diseases 9. Electronic medical records were scanned for patients who fulfilled the following criteria in addition to their claim code: age ≥ 18 years, a diagnosis of rheumatoid arthritis, and/or current or prior use of a disease-modifying antirheumatic drug or biologic agent. Patients with more than one primary or nonmelanoma skin cancer were excluded.

A total of 1719 patients met inclusion criteria. Of these, 563 had received biologic therapy, before and/or after cancer diagnosis. Most were female (72%), with a mean age at cancer diagnosis of 59 ± 13 years. Eighty-one underwent follow-up <3 months after cancer diagnosis and were not included in the analysis; 43 had discontinued biologic therapy before their cancer diagnosis; and 313 were receiving biologic therapy at the time of their cancer diagnosis. In this group 225 (72%) discontinued therapy within 3 months of diagnosis, and 88 (28%) continued treatment. In addition, 126 patients initiated biologic therapy after their cancer diagnosis with a median of 8 (range 0.04–39) years. Overall, 214/1719 (12%) of patients with rheumatoid arthritis received a biologic after their cancer diagnosis. Forty-two percent of the 214 patients were taking a biologic before their cancer diagnosis and continued the therapy. The remaining 58% started the biologic (most commonly a tumour necrosis factor inhibitor) a median of 8 years after their cancer diagnosis. The most common tumour site among the 214 patients was breast (28%) followed by lymphoma and prostate in 7% each, and melanoma in 6%. First biologic therapies included tumour necrosis factor inhibitors (88%), rituximab (7%), abatacept (4%), and tocilizumab (1%). Almost 20% switched biologic therapy at a later stage. Fifty-seven (27%) patients who received biologic therapy harboured active cancer or developed a recurrence during follow-up, and 14 (7%) died. The recurrence/active cancer rate was 12% in first year after starting biologic therapy (or after cancer diagnosis if biologic had been continued), 16% by 2 years, and 33% by 5 years. Dr Zamora concluded that 12% of a cohort of patients with rheumatoid arthritis continued to take biologic therapy after a cancer diagnosis, most frequently a tumour necrosis factor inhibitor. One third harboured active cancer or a recurrence during follow-up. Additional controlled studies are needed to determine whether the risk of cancer recurrence is higher in patients with rheumatoid arthritis receiving biologic therapy after developing cancer. “This might be accomplished by comparing patients who took a biologic after cancer diagnosis versus a control group without rheumatoid arthritis matched by cancer characteristics, sex, and age,” Dr Zamora suggested.

© ACR/ARHP 2016 Annual Meeting • acrannualmeeting.org PRACTICEUPDATE RHEUMATOLOGY & DERMATOLOGY