Abstract
Inflammation and cancer have a profound yet ambiguous relationship. Inflammation - especially chronic inflammation - has protumorigenic effects, but inflammatory cells also mediate an immune response against the tumor and immunosuppression is known to increase the risk for certain tumors.This article reviews current literature on the role of inflammation in cancer and the cancer risk in immune-mediated inflammatory diseases (IMIDs). We discuss the effect on cancer risk of different drug classes used in the treatment of IMIDs treatment, including biologicals such as tumor necrosis factor (TNF) inhibitors.Overall cancer incidence and mortality risk are similar to the general population in inflammatory bowel disease (IBD), and slightly increased for rheumatoid arthritis and psoriasis, with risk profiles differing for different tumor types. Increased risk for non-melanoma skin cancer is associated with thiopurine treatment in IBD, with the combination of anti-TNF and methotrexate in rheumatoid arthritis and with PUVA, cyclosporine and anti-TNF treatment in psoriasis. Data on the safety of using biologic or immunosuppressant therapy in IMID patients with a history of cancer are scarce.This review provides clinicians with a solid background to help them in making decisions about treatment of immune-mediated diseases in patients with a tumor history.This article is related to another review article in Molecular Cancer: http://www.molecular-cancer.com/content/12/1/86.
Highlights
Immune-mediated inflammatory diseases (IMIDs) are a group of chronic and highly disabling diseases involving inappropriate or excessive immune responses caused or accompanied by cytokine dysregulation and acute or chronic inflammation [1]
Risk of cancer associated with immune suppression: transplantation as a model Treatment of IMIDs focuses on inhibiting inflammation by suppressing the activity and proliferation of immune cells and the cytokine production involved in innate and adaptive immune responses [81]
Overall cancer incidence and mortality risk are similar to the general population in inflammatory bowel disease (IBD), and slightly increased for rheumatoid arthritis (RA) and psoriasis
Summary
Immune-mediated inflammatory diseases (IMIDs) are a group of chronic and highly disabling diseases involving inappropriate or excessive immune responses caused or accompanied by cytokine dysregulation and acute or chronic inflammation [1]. Risk of cancer associated with immune suppression: transplantation as a model Treatment of IMIDs focuses on inhibiting inflammation by suppressing the activity and proliferation of immune cells and the cytokine production involved in innate and adaptive immune responses [81]. Meta-analyses of randomized clinical trials, found that the treatment of RA with anti-TNF biologics [121,126,129] or biologics overall [128] does not significantly increase the risk for any type of cancer in RA patients An important limitation of the RCT data in these studies, is the shortness of the follow-up period of the included studies in comparison with the latency period for emergence of cancer. RA, polyarticular juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, plaque psoriasis Juvenile idiopathic arthritis, RA
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