Case Points to Link Between Crohn's Treatment, Cancer

By Steven Reinberg
HealthDay Reporter
Wednesday, July 16, 2008; 6:00 PM

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WEDNESDAY, July 16 (HealthDay News) -- An unusual case involving a sudden remission of lung cancer highlights the carcinogenic potential of certain drugs used to treat Crohn's disease, experts say.

The patient, a 69-year-old female ex-smoker, developed lung cancer while being treated with anti-tumor necrosis factor (TNF) medications for her Crohn's disease.

However, the malignancy vanished after doctors stopped giving her the medications, British researchers report in the July 17 issue of the New England Journal of Medicine.

"There is an underlying concern about the use of these drugs and the possible increase of certain kinds of cancer," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. "This report raises the awareness that doctors and patients have to have in using these drugs. We certainly need to be more vigilant about lung cancer in patients who get these treatments."

The rare case has broader implications and sheds light on the possible effect of anti-TNF medications -- which are also used to treat rheumatoid arthritis -- on patients' immune systems, the team say. This family of biologic drugs includes adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade).

One theory is that the woman, who had been a heavy smoker for 35 years, had had her lung cancer held at bay by her immune system. However, the anti-TNF drugs she was taking for her Crohn's may have weakened that system, allowing the lung cancer to emerge, the researchers say.

The woman's lung malignancy "was expected to be fatal within months," said co-author Jack Satsangi, a professor of gastroenterology at the University of Edinburgh in Scotland. "However, on stopping anti-TNF agents the cancer has completely regressed - and she is healthy more than two years later," he said.

The woman had been diagnosed with lung disease (not cancer) in 1999. In 2000, she was diagnosed with Crohn's disease, which was then treated with TNF medications -- first Remicade, then Humira. In 2006, she was diagnosed with lung cancer.