scholarly journals P729 The SAPPHIRE registry: Safety of immunosuppression in a prospective cohort of inflammatory bowel disease patients with a HIstoRy of CancEr

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S585-S587
Author(s):  
J Axelrad ◽  
J F Colombel ◽  
E Scherl ◽  
D Lukin ◽  
S Chang ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
New York ◽  
Bowel Disease ◽  
Small Sample ◽  
Recurrent Cancer ◽  
Increased Risk ◽  
History Of ◽  
Diagnosis Of Cancer ◽  
Inflammatory Bowel ◽  
History Of Cancer

Abstract Background Previous retrospective studies have demonstrated that patients with inflammatory bowel disease (IBD) exposed to anti-TNF and/or immunomodulators (IMM) following a diagnosis of cancer were not at an increased risk of new or recurrent cancer compared with those unexposed to these agents. Prospective studies are lacking and little is known about cancer risk with ustekinumab and vedolizumab. The SAPPHIRE Registry was developed to prospectively examine whether patients with IBD and a history of cancer subsequently exposed to immunosuppressive IBD therapies are at greater risk of new or recurrent cancer compared with those not exposed to immunosuppression. Methods We are longitudinally following patients with IBD and a histologically confirmed first cancer within the last five years from 8 centres affiliated with the New York Crohn’s and Colitis Organization (NYCCO) between 2017 and 2019. Patients receiving chemotherapy or radiation at enrolment, a first cancer more than 5 years prior to study entry, or recurrent cancer within the last 5 years are excluded. Cancers are categorised into luminal gastrointestinal (GI), hematologic, dermatologic, and other solid malignancies. Our primary outcome is the development of new or recurrent cancer stratified by immunosuppression exposure. Results We identified 170 patients with IBD and a history of a first cancer within the last 5 years (Table 1). The average age at IBD diagnosis was 36 years; average age at cancer diagnosis was 54 years. Patients were 49% male, 91% white, and 39% former smokers. Prior cancers were solid (78; 46%), GI (23; 14%), dermatologic (59; 35%), and hematologic (12; 7%) malignancies. Following a diagnosis of cancer, patients were exposed to IMM (38; 22%), anti-TNF (45; 26%), vedolizumab (41; 23%), ustekinumab (17; 10%), or no immunosuppression (33; 19%; Table 2). During follow-up, 13 (8%) patients developed 14 subsequent cancers (6 new, 8 recurrent) comprising 6 (43%) solid, 1 (7%) gastrointestinal, and 7 (50%) dermatologic malignancies. Compared to patients not exposed to immunosuppression, exposure to an IMM (RR 4.94, 95% CI 0.50, 48.6) or a biologic (RR 3.53, 95% CI 0.71, 17.5) was not associated with an increased risk of new or recurrent cancer. However, exposure to combination therapy with an IMM and a biologic (RR 6.81, 95% CI 1.40, 33.2) was associated with an increased risk in this small sample. Conclusion In this ongoing prospective study, exposure to immunosuppressive IBD monotherapies in patients with IBD and a recent history of cancer has so far conferred no increased risk of new or recurrent cancer. Continued enrolment will enable a more refined estimate of the safety of combination therapies.

Bariatric Surgery in Patients With Inflammatory Bowel Disease: A Case-Control Study from the GETAID

2021 ◽  
Author(s):  
Catherine Reenaers ◽  
Arnaud de Roover ◽  
Laurent Kohnen ◽  
Maria Nachury ◽  
Marion Simon ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Inflammatory Bowel Disease ◽  
Weight Loss ◽  
Bowel Disease ◽  
Small Sample ◽  
Control Group ◽  
Prevalence Of Obesity ◽  
History Of ◽  
Inflammatory Bowel ◽  
Small Sample Sizes

Abstract Background The prevalence of obesity and the number of bariatric surgeries in both the general population and in patients with inflammatory bowel disease (IBD) have increased significantly in recent years. Due to small sample sizes and the lack of adequate controls, no definite conclusions can be drawn from the available studies on the safety and efficacy of bariatric surgery (BS) in patients with IBD. Our aim was to assess safety, weight loss, and deficiencies in patients with IBD and obesity who underwent BS and compare findings to a control group. Methods Patients with IBD and a history of BS were retrospectively recruited to centers belonging to the Groupe d’Etude Thérapeutique des Affections Inflammatoires du Tube Digestif (GETAID). Patients were matched 1:2 for age, sex, body mass index (BMI), hospital of surgery, and type of BS with non-IBD patients who underwent BS. Complications, rehospitalizations, weight, and deficiencies after BS were collected in cases and controls. Results We included 88 procedures in 85 patients (64 Crohn’s disease, 20 ulcerative colitis, 1 unclassified IBD) with a mean BMI of 41.6 ± 5.9 kg/m2. Bariatric surgery included Roux-en-Y gastric bypass (n = 3), sleeve gastrectomy (n = 73), and gastric banding (n = 12). Eight (9%) complications were reported, including 4 (5%) requiring surgery. At a mean follow-up of 34 months, mean weight was 88.6 ± 22.4 kg. No difference was observed between cases and controls for postoperative complications (P = .31), proportion of weight loss (P = .27), or postoperative deficiencies (P = .99). Conclusions Bariatric surgery is a safe and effective procedure in patients with IBD and obesity; outcomes in this patient group were similar to those observed in a control population.

753 A History of Colorectal Neoplasia Is Associated With an Increased Risk of Ileo-Anal Pouch Neoplasia in a Nationwide Inflammatory Bowel Disease Cohort

2013 ◽  
Vol 144 (5) ◽  
pp. S-136-S-137
Author(s):  
Lauranne A. Derikx ◽  
Wietske Kievit ◽  
Dirk J. De Jong ◽  
Cyriel Ponsioen ◽  
Bas Oldenburg ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Colorectal Neoplasia ◽  
Increased Risk ◽  
History Of ◽  
Inflammatory Bowel

Fr514 THE SAPPHIRE REGISTRY: SAFETY OF IMMUNOSUPPRESSION IN A PROSPECTIVE COHORT OF INFLAMMATORY BOWEL DISEASE PATIENTS WITH A HISTORY OF CANCER

2021 ◽  
Vol 160 (6) ◽  
pp. S-340
Author(s):  
Jordan E. Axelrad ◽  
Jean Frederic Colombel ◽  
Ellen J. Scherl ◽  
Dana J. Lukin ◽  
Shannon Chang ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Prospective Cohort ◽  
History Of ◽  
Inflammatory Bowel ◽  
History Of Cancer

Su1849 THE SAPPHIRE REGISTRY: SAFETY OF IMMUNOSUPPRESSION IN A PROSPECTIVE COHORT OF INFLAMMATORY BOWEL DISEASE PATIENTS WITH A HISTORY OF CANCER

2020 ◽  
Vol 158 (6) ◽  
pp. S-673-S-674
Author(s):  
Jordan E. Axelrad ◽  
Jean Frederic Colombel ◽  
Ellen J. Scherl ◽  
Dana J. Lukin ◽  
Shannon Chang ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Prospective Cohort ◽  
History Of ◽  
Inflammatory Bowel ◽  
History Of Cancer

O-005 YI The Risk of Incident Cancer in Patients With Inflammatory Bowel Disease and a History of Cancer Following Immunosuppression Exposure

2014 ◽  
Vol 20 ◽  
pp. S4-S5
Author(s):  
Axelrad Jordan ◽  
Bernheim Oren ◽  
Colombel Jean-Frédéric ◽  
Ananthakrishnan Ashwin ◽  
Yajnik Vijay ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Incident Cancer ◽  
History Of ◽  
Inflammatory Bowel ◽  
History Of Cancer

scholarly journals P733 Past history of bariatric surgery associated with increased risk of new onset inflammatory bowel disease

2017 ◽  
Vol 11 (suppl_1) ◽  
pp. S455-S456 ◽  
Author(s):  
R. Ungaro ◽  
H. Chang ◽  
L. Roque Ramos ◽  
R. Fausel ◽  
J. Torres ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Past History ◽  
Increased Risk ◽  
History Of ◽  
Inflammatory Bowel ◽  
New Onset

Influence of inflammatory bowel disease on the ability of patients to tolerate systemic fluorouracil-based chemotherapy.

1996 ◽  
Vol 14 (7) ◽  
pp. 2043-2046 ◽  
Author(s):  
A Tiersten ◽  
L B Saltz
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Cancer Center ◽  
Gastrointestinal Malignancy ◽  
Severe Diarrhea ◽  
Number Of Patients ◽  
Increased Risk ◽  
History Of ◽  
Inflammatory Bowel ◽  
Severe Grade

PURPOSE To evaluate the safety of administering fluorouracil (5FU)-based chemotherapy to cancer patients with inflammatory bowel disease (IBD). PATIENTS AND METHODS We retrospectively reviewed all patients entered into the Memorial Sloan-Kettering Cancer Center clinical data base from 1985 through 1995 who had a diagnosis of IBD, had a gastrointestinal malignancy, and were treated with systemic 5FU-based chemotherapy. A total of 19 patient charts were identified and reviewed. RESULTS Fifty-three percent of patients reviewed experienced severe (grade III/IV) diarrhea on treatment. Sixty percent of patients with a history of active IBD and 40% of patients with a history of inactive IBD experienced severe diarrhea on treatment. The incidence of severe diarrhea did not appear to be substantially influenced by age, schedule of 5FU administration, concurrent radiation, or type of IBD. CONCLUSION While there does appear to be an increased risk of diarrhea exacerbation in IBD patients treated with 5FU, a substantial number of patients tolerate chemotherapy without increased difficulty. The degree of IBD activity or other clinical parameters can not be used to predict accurately the likelihood of toxicity.

Previous Cancer/Lymphoma and Refractory Inflammatory Bowel Disease

2015 ◽  
Vol 33 (Suppl. 1) ◽  
pp. 44-49 ◽  
Author(s):  
Oren Bernheim ◽  
Jordan Axelrad ◽  
Steven H. Itzkowitz ◽  
Jean-Frederic Colombel
Keyword(s):  
Cancer Recurrence ◽  
Hematologic Malignancies ◽  
Multicentric Study ◽  
Recurrent Cancer ◽  
Incident Cancer ◽  
Increased Risk ◽  
History Of ◽  
Inflammatory Bowel ◽  
History Of Cancer

Immunomodulators and biologic agents are effective in treating inflammatory bowel diseases (IBDs), and recent evidence supports their introduction earlier in the disease course. An important concern to both patients and physicians considering immunosuppression (IS) for the treatment of IBD is the potential associated cancer risk. Several important clinical questions deserve attention with respect to IBD therapy and cancer. First, does medical therapy for IBD predispose to developing cancer? Second, in an IBD patient with a history of cancer, does IBD therapy impact cancer recurrence? Third, once cancer develops in an IBD patient, is the cancer outcome different? Finally, in an IBD patient with current cancer, does the cancer therapy affect IBD outcomes? In a recent multicentric study, patients were identified based on a diagnosis of IBD and cancer with subsequent exposure to anti-tumor necrosis factor α (anti-TNFα arm), thiopurines or methotrexate (antimetabolite arm) or without subsequent IS exposure (control arm). Two hundred and fifty-five patients met the inclusion criteria. Prior cancers included 121 solid, 62 gastrointestinal, 55 dermatologic and 17 hematologic malignancies. During the follow-up period, 75 (29.4%) patients developed incident cancer: 36 (14.1%) a new cancer, 33 (12.9%) a recurrent cancer and 6 (2.4%) a new and recurrent cancer. Incident cancer rate per 100 person-years for patients exposed to anti-TNFα, anti-metabolites and controls was 2.6 with 795 person-years of follow-up, 14.8 with 122 person-years of follow-up and 8.52 with 422 person-years of follow-up, respectively. In this series of IBD patients with a history of cancer, exposure to IS following a cancer diagnosis was not associated with an increased risk of incident cancer compared to patients who did not receive these agents. Prospective data are needed to confirm these findings.

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