SURVIVAL IN PATIENTS WITH RHEUMATOID ARTHRITIS AND EARLY BREAST CANCER TREATED WITH TUMOR NECROSIS FACTOR INHIBITORS
Authors: Maria Suarez-Almazor et al.
The safety of TNF-inhibitors (TNFi) in RA patients with concomitant cancer is of concern, in particular in patients with recent cancer. These researchers from Texas conducted a cohort study of patients with RA recently diagnosed with breast cancer and examined the survival of patients who received TNFi in the first year after breast cancer diagnosis versus patients who received csDMARDs, or no DMARDs. After multivariate and propensity score adjustment, no significant differences in survival rates were observed between patients treated with TNFi and patients treated with csDMARDs alone (hazard ratio, HR=0.75 95% CI 0.41-1.37). Patients receiving prednisone-equivalent doses of 7.5mg/day had worse survival than those who did not receive glucocorticoids (HR=2.51).
Because the prognosis of cancer therapy has improved, cancer is becoming more and more a chronic condition, which means that several of our rheumatic patients may face concomitant cancer on the top of their rheumatic disease. Results from this and other analysis convincingly demonstrate that TNFi and methotrexate do not seem to worsen the prognosis of solid cancers, such as the breast cancer. On the contrary, higher doses of prednisone do carry a detrimental effect on the survival of patients with cancer.
Rheumatologists need to balance the risk of antirheumatic therapy in cancer against the risk of rheumatic disease flares. Accumulating evidence speaks against withholding TNFi or methotrexate if the patient has active rheumatic disease, – even in early cancer. These medications seem to be much less harmful for cancer therapy than glucocorticoids, which can often be avoided by using these DMARDs early enough.