Published online May 21, 2014. doi: 10.3748/wjg.v20.i19.5912
Revised: December 2, 2013
Accepted: January 3, 2014
Published online: May 21, 2014
Adalimumab (ADA) is a tumor necrosis factor (TNF) inhibitor, used for the treatment of inflammatory bowel disease. Previous studies have reported an increased risk of cancer following exposure to TNF inhibitors, but little has been reported for patients with cancer receiving TNF-inhibitor treatment. We present a female patient with metastatic breast cancer and ulcerative colitis (UC) who was treated with ADA. A 54-year-old African American female with a past history of left-sided breast cancer (BC) diagnosed at age 30 was initially treated with left-breast lumpectomy, axillary dissection, followed by chemotherapy and radiation therapy. Years after initial diagnosis, she developed recurrent, bilateral BC and had bilateral mastectomy. Subsequent restaging computed tomography (CT) scan demonstrated distant metastases to the bone and lymph nodes. Three years into her treatment of metastatic breast cancer, she was diagnosed with UC by colonoscopy. Her UC was not controlled for 5 mo with 5-aminosalicylates. Subcutaneous ADA was started and resulted in dramatic improvement of UC. Four months after starting ADA, along with ongoing chemotherapy, restaging CT scan showed resolution of the previously seen metastatic lymph nodes. Bone scan and follow-up positron emission tomography/CT scans performed every 6 mo indicated the stability of healed metastatic bone lesions for the past 3 years on ADA. While TNF-α inhibitors could theoretically promote further metastases in patients with prior cancer, this is the first report of a patient with metastatic breast cancer in whom the cancer has remained stable for 3 years after ADA initiation for UC.
Core tip: Tumor necrosis factor (TNF)-α inhibitors are widely-used and effective treatments for many autoimmune diseases, such as rheumatoid arthritis, inflammatory bowel disease and psoriasis. However, it is believed that TNF-α inhibitors may also place patients at increased risk of cancer occurrence or recurrence. Many studies report increased risk of cancer following exposure to TNF-α inhibitors, but little has been reported for patients with cancer, receiving anti-TNF-α treatment. This is the first case of metastatic breast cancer in long term remission for 3 years in a patient treated with TNF-α inhibitors for ulcerative colitis, suggesting that patients with metastatic cancer could be treated with this class of medications without worsening.