Jordan E. Axelrad
Patients with inflammatory bowel disease who are also undergoing hormone therapy for prostate or breast cancer have an increased risk for IBD relapse and other adverse outcomes, according to study results.
Jordan E. Axelrad, MD, MPH, of the IBD Center at NYU Langone Health, said he first conducted a small study several years ago examining the impact cancer treatment had on the course of IBD.
“In that study, IBD patients who received cytotoxic chemotherapy were likely to remain in remission of their IBD whereas those who received hormone agents were likely to flare,” Axelrad told Healio Gastroenterology and Liver Disease. “The finding that hormone agents may negatively impact IBD was unexpected. Using the academic centers affiliated with the New York Crohn’s and Colitis Organization (NYCCO), a research consortium comprising the major academic centers in New York, we attempted to specifically evaluate the role of hormone agents on the course of IBD by focusing on the most common cancers that often require hormone agents, breast and prostate cancer.”
As a result, Axelrad and colleagues wrote that patients with IBD and cancer need special attention because of the therapies needed to control inflammation and other disease complications.
“Gastroenterologists and oncologists are increasingly confronted with questions regarding the management of patients with IBD who are diagnosed with cancer,” they wrote. “Understanding the effect of cancer treatment on IBD activity may help identify patients at the highest risk for IBD exacerbation during and after specific cancer treatments and may provide guidance on selection or dosing of cancer therapies, timing of cancer therapies, and continuation or reintroduction of IBD therapies.”
To explore the impact of hormone cancer therapies on IBD, researchers analyzed data from five centers on 447 patients with IBD who later received a diagnosis of breast or prostate cancer from 1997 to 2018. IBD relapse for patients with quiescent IBD at cancer diagnosis (n = 400) and IBD remission in patients with active IBD at cancer diagnosis (n = 47) served as the primary endpoint.
Investigators found that among patients with inactive IBD at diagnosis, 112 later developed active disease (28%). They determined that previous exposure to steroids (HR = 1.79; 95% CI, 1.18–2.71), immunomodulators (HR = 2.22; 95% CI, 1.38–3.55) or biologics (HR = 1.95; 95% CI, 1.01–5.36) was associated with IBD relapse after cancer diagnosis.
Looking specifically at cancer treatments, Axelrad and colleagues found that hormone monotherapy (HR = 2; 95% CI, 1.21–3.29) and combination cytotoxic and hormone therapy (HR = 1.86; 95% CI, 1.01–3.43) were associated with IBD relapse. Among patients who received hormone monotherapy, 42% stayed in remission from IBD at 250 months compared with 75% of patients who received only cytotoxic chemotherapy.
Among patients with active IBD at the time of cancer diagnosis, researchers found that 14 entered remission from IBD. However, they found no significant factors associated with IBD remission.
“These results may provide guidance for developing treatment plans and anticipating IBD activity in patients undergoing cancer treatment involving hormone therapies,” Axelrad said. “As breast and prostate cancer are the most common cancers in general population with hormone therapy a mainstay of treatment, these patients should be considered for closer monitoring of IBD activity with a low threshold to escalate IBD therapy.”
Axelrad did note, however, that there were some limitations to the study including a retrospective design and broad definitions for types of cytotoxic and hormone therapies.
“We were underpowered to examine the impact of specific chemotherapy or hormone therapy regimens and associated dosing protocols on the course of IBD,” he said. “In addition, our institutions are major referral centers and our data may not be generalizable to other clinical settings.” – by Alex Young and Ryan McDonald
Disclosures: Axelrad reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.