COMMENTARY

TNF Inhibitors and Breast Cancer Recurrence

Jonathan Kay, MD

Disclosures

September 30, 2014

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Hello. I am Dr Jonathan Kay, professor of medicine and director of clinical research in the Division of Rheumatology at the University of Massachusetts Medical School and UMass Memorial Medical Center, both in Worcester, Massachusetts. Welcome to my Medscape blog.

Today I am going to talk about a very interesting article that was published online on August 8, 2014, in the Annals of Rheumatic Diseases.[1] This is a study that addressed the relative effect of tumor necrosis factor (TNF) inhibitor therapy on recurrence of breast cancer in women with previously treated breast cancer.

As has been shown, patients with rheumatoid arthritis have an increased risk for lymphoma related to the degree of inflammation in rheumatoid arthritis.[2] However, the risk for breast cancer and colon cancer appears to be lower in individuals with rheumatoid arthritis than in the general population. Recurrence of cancer is also a consideration in patients treated with TNF inhibitors. For example, melanoma has been shown to occur more frequently in individuals treated with TNF inhibitors than in those who are not treated with TNF inhibitors.[3]

What about breast cancer? This is a concern because breast cancer commonly occurs in women, and many women are treated with TNF inhibitors for rheumatoid arthritis.

Swedish Registries Provide an Answer

This study by Raaschou and colleagues, Johan Askling's group from the rheumatoid arthritis registry in Sweden (ARTIS), linked the ARTIS registry data to the Swedish cancer registry. They identified 120 women with breast cancer who had been treated with TNF inhibitors after the diagnosis of breast cancer, and matched them to another 120 women who had breast cancer but were treated with nonbiologic disease-modifying antirheumatic drugs (DMARDs).

They found that nine women in each group developed recurrent breast cancer, for a relative risk of 1.1 for the recurrence of breast cancer in individuals treated with TNF inhibitors vs those with nonbiologic DMARD therapy. With an average duration of follow-up of 9.4 years, this lack of increased risk for recurrent breast cancer seems reassuring.

Thus, it is reasonably comforting that one can use TNF inhibitors to treat rheumatoid arthritis in women with a breast cancer history. Poor-prognosis breast cancer was not included in this study, however, so there are some limitations with the findings of this study. The recurrence of other cancers, such as colon cancer and other malignancies, should also be looked at.

Regardless, this study by Raaschou and colleagues from Sweden seems to indicate that we can use TNF inhibitors to treat patients with active rheumatoid arthritis who also have had previously treated breast cancer.

I hope that this blog has been informative. I welcome your questions and look forward to seeing you again on Medscape. Thank you very much for your attention.

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