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EULAR: Balancing Treatment Risks for Inflammatory Arthritis and Cancer


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The European Alliance of Associations for Rheumatology (EULAR) introduced new points to consider surrounding the initiation of targeted therapies in patients with inflammatory arthritis and a history of cancer, according to recent recommendations published by Sebbag et al in the Annals of the Rheumatic Diseases.

Background

Many autoimmune and inflammatory diseases may be associated with higher rates of some cancer types as a result of the underlying disease. Several autoimmune or inflammatory diseases are known to be associated with an increased cancer risk. This can be the result of the underlying inflammation and autoimmunity, comorbidities, or shared risk factors between inflammatory arthritis and some types of cancer. Patients who have had cancer in the past may be reluctant to receive antirheumatic drugs that could increase their risk of cancer recurrence; however, there are also inherent risks in leaving inflammatory arthritis untreated.

Overview of Points to Consider

In the recommendations, investigators included five overarching principles and eight individual points to consider. The principles stressed that this new guidance should be used alongside the main EULAR recommendations for each specific type of inflammatory arthritis and suggested that both new and recurrent cancer cases can occur in patients with inflammatory arthritis who have a history of cancer.

The recommendations underscored that patients' individual risk of cancer recurrence should be assessed on the basis of their medical history and underlying disease. Ultimately, the treating rheumatologist may be responsible for managing inflammatory arthritis regardless of whether patients have had cancer in the past. All treatments should seek to achieve the greatest possible outcomes for their diseases but must be based on shared decision-making among patients, their rheumatologist, and their oncology team.

Conclusions

EULAR hopes that the new publication will provide guidance for clinical practice as well as help health-care providers manage targeted therapies in patients with inflammatory arthritis and a previous malignancy. The recommendations may also assist in managing treatment decisions between different health-care teams, ensuring that all risks and benefits are considered.

Disclosure: For full disclosures of the recommendation authors, visit ard.bmj.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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