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Immunotherapy is a treatment that boosts or manipulates the immune system to fight diseases, including cancer. For instance, by stimulating an immune response through vaccinations against viruses that cause cancers, like hepatitis B virus and human papillomavirus, these diseases can be prevented. Nonetheless, some cancer cells can avoid the immune system due to their rapid mutation and division. The immune response to many cancers involves three phases: elimination, equilibrium, and escape.
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Cutaneous malignancy after biologic therapy for inflammatory disease: An active comparator, retrospective cohort

Kyle C Lauck1, Areeba Ahmed2, Michael J Davis3

  • 1Division of Dermatology, Department of Medicine, Baylor University Medical Center, Dallas, Texas.

Journal of the American Academy of Dermatology
|May 23, 2025
PubMed
Summary

Biologic therapies, particularly tumor necrosis factor inhibitors, are linked to a small increase in nonmelanoma skin cancer risk for patients with inflammatory diseases. Careful patient selection is crucial.

Keywords:
Janus kinase inhibitorsbiologic therapycutaneous malignancyinflammatory bowel diseasepsoriasisrheumatoid arthritis

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Area of Science:

  • Dermatology
  • Rheumatology
  • Gastroenterology
  • Oncology

Background:

  • The association between biologic therapies and skin cancer risk in patients with inflammatory diseases (ID) remains unclear.
  • Patients with ID have an inherent elevated risk of skin cancer, independent of treatment.
  • Limited longitudinal data exist that adequately control for ID-related confounding factors when evaluating biologic safety.

Purpose of the Study:

  • To evaluate the risk of developing cutaneous malignancy following biologic therapy for inflammatory diseases.
  • To conduct head-to-head comparisons of different biologics to mitigate confounding risks associated with the underlying inflammatory disease.

Main Methods:

  • Analysis of a large dataset (1,759,200 patients) from the TriNetX network (2004-2024) including patients with psoriasis, rheumatoid arthritis, and inflammatory bowel disease.
  • Calculation of cutaneous malignancy risk following exposure to various biologic therapies.
  • Application of propensity score matching to control for potential confounding variables.

Main Results:

  • Approximately 12.1% of patients (212,632) received biologic therapy for their inflammatory condition.
  • A statistically significant, though small, increase in the absolute risk of nonmelanoma skin cancer was observed, primarily associated with tumor necrosis factor (TNF) inhibitors.
  • No significant increase in skin cancer risk was identified for other individual biologic agents studied.

Conclusions:

  • The study confirms a link between TNF inhibitors and an increased risk of nonmelanoma skin cancer.
  • While other biologics like interleukin and Janus kinase inhibitors may pose a minimal risk, the findings emphasize the need for personalized biologic selection in managing inflammatory diseases.
  • Limitations include the retrospective nature of the study and potential data inaccuracies inherent in electronic medical records.