Practical guidance for the management of inflammatory bowel disease in patients with cancer. Which treatment?

Clinicians involved in the treatment of inflammatory bowel disease (IBD) increasingly come across patients with current or previous history of malignancies. With increasing and earlier use of immunosuppression and biologics in IBD patients, the question arises whether these treatments further increase the risk of new or recurrent cancers. A number of population-based observational studies have now reported the odds of development of new or recurrent cancers with thiopurines and antitumour necrosis factors (anti-TNFs). These data combined with data arising from treatment registries from other immune disorders such as rheumatoid arthritis are providing evidence of relative risks and safety profiles of these agents in the setting of active or prior cancer. Data from transplant literature give an indication for providing a drug-holiday period in patients with treated cancers. The risks of the treatment should be considered alongside the risk associated with withholding these effective treatments in patients with active IBD. In this review, we aim to summarize the current evidence in this area and provide a practical guidance.