Jordan Axelrad, MD, on Patients With IBD and Malignancy

Dr Axelrad recaps his presentation from the Advances in Inflammation Bowel Diseases regional meeting on treating patients with IBD who have a history of cancer or have been diagnosed with a malignancy.

Jordan Axelrad, MD, is director of Clinical and Translational Research and an inflammatory bowel disease specialist at NYU Langone Health in New York City, New York.

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TRANSCRIPT:

Jordan Axelrad:
I am Jordan Axelrad and I'm an inflammatory bowel disease specialist at NYU Langone. And you just heard me speak at AIBD Regional Virtuals about patients with IBD and malignancy. Patients with IBD are at an increased risk of cancer, both due to their underlying inflammatory disease and also some of the drugs that we give patients to mitigate this inflammation. Now, despite what we know about the absolute and relative risks of cancer in patients with IBD, when a patient of ours is diagnosed with cancer, many things happen. We know that I B D therapy often gets modified.

We know that the cancer therapy often gets modified and all in patients with IBD tend to tolerate cancer treatment, chemotherapy, radiation, immunotherapy, similar to non IBD patients. And then furthermore, there are very little data regarding immunosuppression for IBD in active malignancy. And so this is very important for providers to keep in mind is that an IBD diagnosis in studies has frequently impacted both the IBD course and the cancer course as far as therapies are concerned. However, they're limited data to suggest modifying both the course of IBD with therapy changes and chemotherapy plans and cancer treatment plans actually has an impact on disease activity.

And so what's important is that cancer treatment is guided by what a patient needs, and IBD treatment is guided by what the patient needs and that's what's most important. Furthermore, many of our patients are concerned about the risks of cancer, in particular in patients who have a history of cancer. So as our patient population of patients with IBD ages, there's an increased risk of cancer. Many more of our patients will have a history of cancers and we now have preliminary and emerging data that suggests all of our agents are relatively safe in patients who have a history of cancer.

So in some population and retrospective studies, we've seen that exposure to various therapy mechanisms, anti-TNF, immunomodulators, IL-12/23, anti-integrin, and even JAK inhibitors in few studies have demonstrated not to increase the risk of new or recurring cancer in patients who have a history of cancer. So therefore, again, very important that when we have patients who have a cancer diagnosis, we do what's needed for the patient's disease and not just based on a history.

With all of that information, it's also important for us as providers to help patients understand and put in perspective overall the very low absolute risk of cancer associated with IBD and IBD therapies. Although relative risks may be increased, this absolute risk is actually quite low. And so we have to make sure that we're doing what's needed based on disease activity and again, not just on a cancer history for our individual patients. Thank you.

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