Wednesday, 18 Sep 2019

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Prior Cancer Patients May Safely Receive TNF Inhibitors or Rituximab

Current guidelines regarding the use of biologics in patients who have previously had a malignancy are based more on opinion than evidence.

The ARTIS registry previously showed that women with a prior breast cancer who went on to receive a TNF inhibitor (TNFi) were not at great risk of breast cancer recurrence ( They have also showed that cancers occurring after initiation of TNFi therapy do not have worse outcomes or reduced survival compared to cancer patients not exposed to TNFi (

The British Biologics Registry (BSRBR) examined 425 patients with a prior malignancy and assessed rates of recurrent malignancy in  patients treaed with either a TNFi, rituximab (RTX) or synthetic DMARDs (sDMARD).

Roughly one-quarter developed a new malignancy. The incident malignancy rates and adjusted hazard ratios (HR) were:

 Cancer Recurrence TNFiRTXsDMARD

Recurrent Malignancy Rate/1000OPY

Hazard Ratio0.550.43-
(95% CI) (0.35, 0.86)(0.10, 1.80-


The 17.0% of patients in the sDMARDs cohort had a recurrence of the same cancer in comparison with the 12.8% and the 4.3% in the TNFi and RTX cohorts.

These findings suggest that RA patients with a prior malignancy may be safetly treated with either a TNFi or RTX.

The author has no conflicts of interest to disclose related to this subject

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