medwireNews: A retrospective cohort study suggests that tumor necrosis factor (TNF) inhibitors do not adversely affect survival in patients with rheumatoid arthritis (RA) who begin treatment within 3 years of being diagnosed with early-stage colorectal, lung, or prostate cancer.
The results indicate that the 5-year rates of overall survival (OS) and cancer-specific survival (CSS) in these patients were comparable to those for their peers taking conventional synthetic disease-modifying antirheumatic drugs (DMARDs).
As reported in The Lancet Rheumatology, Maria Suarez-Almazor, from The University of Texas MD Anderson Cancer Center in Houston, USA, and colleagues collated information from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset.
The study included 1981 patients aged 66 years and older with RA who were diagnosed with localized or regional colorectal (n=514; mean age 76.1 years, 75% women), lung (n=864; mean age 74.8 years, 73% women), or prostate cancer (n=603; mean age 73.1) between 2008 and 2019.
Patients taking TNF inhibitors within the first year of being diagnosed with colorectal, lung, or prostate cancer had a respective 28%, 30%, and 20% lower 5-year risks for all-cause death than those taking conventional synthetic DMARDS, after taking into account factors including demographics, comorbidity, and cancer characteristics and treatment. However, these differences did not reach statistical significance.
Specifically, among colorectal cancer patients, 28% died overall and 6% died from colorectal cancer over a median follow-up of 3.7 years. The 5-year Kaplan–Meier estimates for OS were 71% among the 80 patients taking TNF inhibitors within the first year of diagnosis, 62% among the 324 taking conventional synthetic DMARDs, and 68% for the 110 not taking DMARDs. The CSS rates were 94%, 93%, and 88%, respectively. The investigators note that when TNF inhibitor use was analyzed as a time-varying covariate, it was found to be significantly associated with a 38% lower risk for death compared with no TNF inhibitor use.
For the lung cancer patients, the median follow-up was 2.7 years, during which time 51% of patients died and18% died due to cancer. The 5-year OS rate with the use of TNF inhibitors within the first year of diagnosis was 49% versus 39% with conventional synthetic DMARDs, and 38% with no DMARDs. The respective lung CSS rates were 85%, 74%, and 72%.
There was no significant difference in OS between patients with lung cancer who took TNF inhibitors and those who took conventional synthetic DMARDs in the first 2 years of being diagnosed, but there was a significant difference by year 3, with a 42% reduction in the risk for overall death among the 57 patients who were taking TNF inhibitors versus the 269 who were taking conventional synthetic DMARDs at this timepoint. For CSS, there was a significant difference in the first year, with a 60% reduction in the risk for cancer-specific death among the 102 patients taking TNF inhibitors versus the 604 taking conventional synthetic DMARDs.
In all, 16% of the prostate cancer patients died over a median follow-up of 4.2 years, with fewer than 2% of deaths in the cohort due to cancer. The estimated 5-year OS rates for treatment within the first year were a comparable 82% with the use of TNF inhibitors, 75% with conventional synthetic DMARDs, and 82% with no DMARDs, and there were also no significant differences in CSS rates, at 98%, 97%, and 100%, respectively.
The authors note in a key secondary finding that “[p]atients who received glucocorticoids in the first year had significantly worse overall survival and cancer-specific survival than those who did not.”
For example, the hazard ratio (HR) for death among those taking a mean daily glucocorticoid dose of 7.5 mg or higher within the first year of a cancer diagnosis, compared with no use, was a significant 2.10 in those with prostate cancer and 2.91 in those with colorectal cancer, while for cancer-specific death, the HRs were a significant 1.75 among those with lung cancer and 5.55 among those with colorectal cancer.
Suarez-Almazor and team say that patients with early-stage colorectal, lung, or prostate cancer “might be able to continue or start treatment with TNF inhibitors after discussion with their health-care providers,” adding that "additional research is needed to determine the safety of TNF inhibitors when used for longer than 3 years, or in patients with other cancer types."
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