Comparative Risk of Incident Cancer in Patients with Inflammatory Bowel Disease with Prior Non-digestive Malignancy According to Immunomodulator: a Multicentre Cohort Study

F Poullenot (1) , A Amiot (2) , M Nachury (3, 4) , S Viennot (5) , R Altwegg (6) , Y Bouhnik (7) , V Abitbol (8) , S Nancey (9, 10, 11) , L Vuitton , L Peyrin-Biroulet (12) , A Biron , Mathurin Fumery (13, 14) , L Picon , M Vidon , C Reenaers (15) , M Serrero (16) , G Savoye , L Beaugerie (17) , P Rivière (18) , D Laharie (19)

1 CHU Bordeaux
2 CHU Henri Mondor [Créteil]
3 Hôpital Claude Huriez [Lille]
4 INFINITE (Ex-Liric) - Institute for Translational Research in Inflammation - U 1286
5 CHU Caen
6 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
7 CHU Clichy
8 Service de Gastro-entérologie [CHU Cochin]
9 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
10 HCL - Hospices Civils de Lyon
11 CIRI - Centre International de Recherche en Infectiologie
12 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
13 PERITOX - Périnatalité et Risques Toxiques - UMR INERIS_I 1
14 CHU Amiens-Picardie
15 CHU-Liège - Centre Hospitalier Universitaire de Liège
16 CHU Marseille
17 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
18 Service d'hépato-gastroentérologie
19 IBCP - Institut de biologie et chimie des protéines [Lyon]

Abstract Introduction Knowledge about the cancer risk when initiating a biologic in inflammatory bowel disease [IBD] patients with prior malignancy remains scarce, especially for vedolizumab. Our aim was to evaluate the rate of incident cancer in a cohort of IBD patients with prior non-digestive malignancy, according to the subsequent treatment given. Methods A multicentre retrospective study included consecutive IBD patients with prior non-digestive malignancy. Inclusion date corresponded to the diagnosis of index malignancy. Patients were categorized into different cohorts according to the first treatment [none, conventional immunosuppressant, anti-TNF, or vedolizumab] to which they were exposed after inclusion and before incident cancer [recurrent or new cancer]. Results Among the 538 patients {58% female; mean (standard deviation [SD]) age inclusion: 52 [15] years} analyzed, the most frequent malignancy was breast cancer [25%]. The first immunomodulator given after inclusion was a conventional immunosuppressant in 27% of patients, anti-TNF in 21%, or vedolizumab in 9%. With a median (interquartile range [IQR]) follow-up duration of 55 [23-100] months, 100 incident cancers were observed. Crude cancer incidence rates per 1000 person-years were 47.0 for patients receiving no immunomodulator, 36.6 in the anti-TNF cohort, and 33.6 in the vedolizumab cohort [p = 0.23]. Incident-cancer free survival rates were not different between patients receiving anti-TNF and those receiving vedolizumab [p = 0.56]. After adjustment, incidence rates were not different between patients receiving no immunomodulator, anti-TNF, or vedolizumab. Conclusions In this large multicentre cohort study, there was no difference of cancer incidence in those IBD patients with prior non-digestive malignancy, treated with vedolizumab or anti-TNF.

Mots clés: Inflammatory Bowel Diseases/drug therapy; Neoplasms/chemically induced; Adolescent; cancer; Cohort Studies; Female; Gastrointestinal Agents/therapeutic use; Humans; IBD; Immunosuppressive Agents/therapeutic use; incident cancer; incident-cancer free survival; Male; Retrospective Studies; Tumor Necrosis Factor Inhibitors

Domaines: Médecine humaine et pathologie

F Poullenot, A Amiot, M Nachury, S Viennot, R Altwegg, et al.. Comparative Risk of Incident Cancer in Patients with Inflammatory Bowel Disease with Prior Non-digestive Malignancy According to Immunomodulator: a Multicentre Cohort Study. Journal of Crohn's and Colitis, 2022, 16 (10), pp.1523-1530. ⟨10.1093/ecco-jcc/jjac061⟩. ⟨hal-03856600⟩