Extraintestinal neoplasms related to the treatment of Inflammatory Bowel Diseases (Atena Editora)

Abstract

Background: The main representatives of Inflammatory Bowel Diseases (IBD) are Crohn's Disease (CD) and Ulcerative Colitis (UC), which occur with dysregulation of the immune system and chronic inflammation of the digestive tract. Treatment includes aminosalicylates, immunosuppressants, corticosteroids and biological agents. There is already evidence that IBD patients have a higher risk of developing colorectal cancer. However, the association with extraintestinal cancer is still poorly studied. The use of drugs to treat IBD, associated with systemic immune dysregulation, can decrease the body's defense against the development of malignancies. Objective: To conduct an integrative review on extraintestinal neoplasms that may occur as a consequence of the treatment of inflammatory bowel diseases. Methods: An integrative review was carried out to investigate the possible relationship between the treatment of inflammatory bowel diseases and the increased incidence of extraintestinal neoplasms. Data sources included PubMed, Scielo and Elsevier/ScienceDirect, with specific search strategies. The selection of studies was based on analyzing the titles and reading the full texts. Cohort studies published between 2013 and 2023 were included. Exclusion criteria were applied to eliminate out-of-scope studies. Data collection was conducted using a validated questionnaire, and seven articles were finally included in the review. Results: Yadav et al. found no statistically significant increase in overall cancer risk with the use of aminosalicylates, corticosteroids, immunosuppressants or anti-TNF agents. However, there was an increased risk of melanoma in patients treated with corticosteroids and immunosuppressants. Ostermann et al. showed an increased risk of non-melanoma skin cancer and other malignancies with the use of combination therapy of adalimumab with immunosuppressants. However, they found no significant results with the use of adalimumab monotherapy. Khan et al. showed a higher risk of lymphoma in patients treated with thiopurines, increasing significantly after 4 years of therapy. Ólen et al. showed an increased risk of lymphoma in CD patients undergoing combined therapy (immunosuppressant and biologic) and second-line biologics. Lopez et al. found no increased risk of myeloid disorders with thiopurines, but there was an increased risk in patients with past exposure to these. Rungoe et al. observed an increased risk of high-grade squamous intraepithelial lesions in patients who used TNF-α and azathioprine for a prolonged period. Long-term exposure did not affect the risk of low-grade intraepithelial lesions or cancer in CD or RCU. Finally, Rouvroye et al. found no association between immunosuppressive therapy and the risk of vulvovaginal cancer. Patients who used immunobiological drugs had a younger age at diagnosis of vulvar or vaginal cancer. Conclusions: This integrative review reveals diverse results on the impact of treatments for Inflammatory Bowel Diseases on extraintestinal malignancy rates. The complexity of cancer risk assessment highlights the need for a personalized therapeutic approach, considering individual factors, duration of treatment and specific choice of drugs, highlighting the importance of further research to guide safer and more effective therapeutic strategies for IBD patients.