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Treating rheumatic patients with a malignancy
Katarzyna Elandt1, Daniel Aletaha
1Division of Oncology, Department of Internal Medicine 1, Medical University Vienna, Austria.
Arthritis Research & Therapy
|July 5, 2011
Summary
Managing inflammatory rheumatic diseases in cancer survivors presents challenges due to limited direct evidence on malignancy risk. Careful monitoring and shared decision-making between rheumatologists and oncologists are crucial for patient safety.
Area of Science:
- Rheumatology
- Oncology
- Immunosuppression
Background:
- Patients with inflammatory rheumatic diseases and a history of malignancy require careful management.
- Direct evidence on the risk of recurrent or new malignancy in these patients is scarce.
- Risk assessment often relies on indirect data, such as drug carcinogenicity and transplant literature.
Purpose of the Study:
- To explore the challenges and considerations in managing patients with inflammatory rheumatic disease and a history of cancer.
- To review the indirect evidence regarding malignancy risk in this patient population.
- To emphasize the importance of collaborative decision-making and monitoring.
Main Methods:
- Review of existing literature on malignancy risk associated with immunosuppressive drugs.
- Analysis of cancer reactivation data from transplant literature.
- Examination of limited studies on rheumatic patients with a cancer history.
Main Results:
- Combination immunosuppressive treatment generally increases cancer risk.
- The risk associated with individual immunosuppressive drugs (except alkylating agents) is largely unclear.
- Existing studies in rheumatic patients with cancer history have not shown increased cancer reactivation, but these were small.
- Cancer risk appears to decrease over time after successful cancer treatment.
- Reactivation risk is influenced by the prior malignancy's site and location.
Conclusions:
- Shared decision-making between rheumatologists and oncologists is essential for initiating immunosuppressive therapy in cancer survivors.
- Close and intensive monitoring of these patients is required after treatment decisions are made.
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