摘要
在炎症性肠病(IBD)患者中,巯嘌呤类药物促进EB病毒(EBV)相关的淋巴瘤、非黑色素瘤和尿路癌症的致癌作用,而抗肿瘤坏死因子药物可能促进黑色素瘤的致癌作用。有癌症史的IBD患者比无癌症史的IBD患者具有更高的初发或复发癌症的风险,这与免疫抑制剂的使用无关。在移植病人中,癌症复发率高与巯嘌呤药物的使用有关,尤其是在移植后的前两年内。在慢性炎症疾病患者中,有限的数据表明重大癌症复发发生率与巯嘌呤药物和抗肿瘤坏死因子药物的使用无关。然而,在大多数易患癌症诊断并治疗后通过免疫抑制剂的一个两年药物假期是合理的。在有癌症史并伴随移植后高复发率的患者中,应该考虑将免疫抑制剂药物假期持续期延长至5年。可根据先前的癌症类型,在癌症治疗后可以启动和继续的免疫抑制剂治疗。所有个体决策都应在个案和肿瘤学家的意见基础上,根据典型特征和癌症预期进化、癌症进化中免疫抑制剂的预期影响和IBD的固有严重性以及相关风险而作出。
关键词: 生物制剂,癌症复发,免疫抑制疗法,第二癌症
Current Drug Targets
Title:Management of Inflammatory Bowel Disease Patients with a Cancer History
Volume: 15 Issue: 11
Author(s): Laurent Beaugerie
Affiliation:
关键词: 生物制剂,癌症复发,免疫抑制疗法,第二癌症
摘要: In Inflammatory Bowel Disease (IBD) patients, thiopurines promote carcinogenesis of Epstein-Barr Virus (EBV)-related lymphomas, non-melanoma skin cancers and urinary tract cancers, while anti-TNF agents could promote carcinogenesis of melanomas. Patients with IBD and previous cancer are at a higher risk of developing new or recurrent cancer than IBD patients without a history of cancer, irrespective of the use of immunosuppressants. In transplant recipients, the use of thiopurines is associated with a high rate of cancer recurrence, particularly within the first two years following transplantation. In patients with chronic inflammatory disease, limited data suggest that no dramatic incidence of cancer recurrence is associated with the use of thiopurines or anti-TNF agents. However, there is a rationale for a two-year drug holiday from immunosuppressants after the diagnosis and treatment of the majority of incident cancers, as often as possible. Extending the duration of the immunosuppressant drug holiday to 5 years in patients with previous cancers associated with a high risk of recurrence in the post-transplant state should be considered. The immunosuppressants that can be initiated or resumed after cancer treatment should be chosen according to the type of the previous cancer. All individual decisions should be made on a case-by-case basis, together with the oncologist, according to characteristics and expected evolution of the index cancer, expected impact of the immunosuppressants on cancer evolution, and intrinsic severity of IBD, with its associated risks.
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Cite this article as:
Beaugerie Laurent, Management of Inflammatory Bowel Disease Patients with a Cancer History, Current Drug Targets 2014; 15 (11) . https://dx.doi.org/10.2174/1389450115666140821113330
DOI https://dx.doi.org/10.2174/1389450115666140821113330 |
Print ISSN 1389-4501 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-5592 |
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