Consensus guidelines for management of comorbid RA, cancer examined
medwireNews: A systematic review of consensus recommendations for the management of rheumatoid arthritis (RA) in patients with cancer shows agreement in some areas, but highlights the need for further research into topics for which discrepancies exist.
Maria Lopez-Olivo (The University of Texas MD Anderson Cancer Center, Houston, USA) and colleagues analyzed 39 clinical practice recommendations – from 14 countries, including six international collaborations – that referred to cancer-specific guidance on the management of RA.
They report in Arthritis Care & Research that some agreement across guidelines was observed for cancer risk, screening, monitoring, and management of RA in patients with a new or recent (<5 years) diagnosis of cancer.
For instance, 79% of the consensus documents noted an increased risk for cancer – especially for lymphoma, but also for lung cancer, melanoma, and non-melanoma skin cancer – in RA patients.
And 42% recommended screening for cancer before initiating treatment for RA, and the same proportion highlighted the need for routine monitoring for the signs and symptoms of cancer during treatment.
However, there was disagreement regarding how comprehensive the screening should be and not much information on the symptoms to be aware of during monitoring.
Similarly, although most of the guidelines stated that biologic DMARDs should be stopped in patients newly diagnosed with cancer and advised caution when prescribing biologic DMARDs for patients with a history of cancer, there appeared to be no consensus regarding the treatment of RA in individuals at risk for cancer.
The recommendations generally cautioned against the use of tumor necrosis factor inhibitors in patients with a history of cancer, particularly when the cancer was lymphoma or another hematologic malignancy, but many of the guidelines considered rituximab to be an “adequate” biologic DMARD in these patients, say Lopez-Olivo et al.
“Disagreements [across guidelines] were generally related to the areas with lacking evidence,” the team writes.
“Our findings suggest that additional research is needed on the effect of specific DMARDs on different types of cancers, at different stages to provide personalized recommendations for patients with cancer and RA, considering effects on recurrence and disease progression, quality of life, and patient preferences.”
Noting that none of the documents “resulted from the combined expertise of oncologists, radiotherapists, rheumatologists, and patients,” the researchers emphasize the “urgent need for research and expert opinion to guide and standardize the management of RA in patients with cancer.”
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