211 A Pilot Study of Optimized Monotherapy With Infliximab for Patients With Inflammatory Bowel Disease

Abstract

diagnosis were collected. A possible association between IBD therapy and malignancy risk, and the treatment and evolution of cancer were also reviewed. Results: Ninety six IBD patients (47 Crohn's disease, 47 ulcerative colitis, 2 unclassified colitis) and 107 tumors were studied. Mean age was 58±14 years, 57% males, 38% smokers, 25% with family history of cancer. Seventeen tumors (15.9%) were diagnosed in patients receiving treatment with thiopurines, 3 in patients on methotrexate (2.8%), 2 during anti-TNFα therapy (1.9%), and 11 were identified in patients on combined therapy with an immunosuppressive (9 thiopurines and 2 methotrexate) and an anti-TNFα drug (10.3%). The median duration of treatment was: 72 months for thiopurines (IQR 6-102) and 6 months for adalimumab or infliximab (IQR 2-13). After the diagnosis of cancer, IBD treatment was maintained in 8 (47.1%) patients on thiopurines and in 1 (11.1%) patient with combined therapy. In the remaining patients on immunosuppressive and/or anti-TNFα drug (n=24), the treatment was withdrawn, and in 5 (20.8%) of these cases the therapy was reintroduced later in agreement with the Oncology team. We could not find an association between thiopurines/ anti-TNFα drugs and malignancy risk. Regarding the evolution of cancer, 55 tumors (51.4%) were managed only with oncological surgery, 9 (8.4%) with chemotherapy, 2 (1.9%) with radiotherapy and 33 tumors (30.8%) with combined therapy. Of these therapies, 82.5% were curative and 17.5% were palliative intent treatments. Patients were followed-up for a median of 39 months (IQR 24-57) from tumor diagnosis. During this period, 15 patients died (15.6%) due to cancer (mean age= 66±13 years), 4 (4.2%) had tumor recurrence and 77 (80.2%) patients remained in remission. Conclusions: 1.) Thiopurine treatment is maintained in approximately half of IBD patients after a cancer diagnosis. In contrast, antiTNFα drugs are withdrawn in most cases. 2.) An association between these drugs and a higher cancer risk was not found in our series; these findings support the subsequent reintroduction of these therapies in selected patients, always in agreement with the oncologist's recommendations.