Axelrad JE¹, Bazarbashi A², Zhou J³, Castañeda D⁴, Gujral A⁵, Sperling D⁶, Glass J⁷, Agrawal M⁸, Hong S⁹, Lawlor G¹⁰, Hudesman D¹¹, Chang S¹¹, Shah S¹², Yajnik V⁵, Ananthakrishnan A⁵, Khalili H⁵, Colombel JF¹³, Itzkowitz S¹³; New York Crohn’s and Colitis Organization (NYCCO). Clin Gastroenterol Hepatol. 2019 Jul 11. pii: S1542-3565(19)30735-9. doi: 10.1016/j.cgh.2019.06.042. [Epub ahead of print]

Author information

1 Inflammatory Bowel Disease Center at NYU Langone Health, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY. Electronic address: Jordan.Axelrad@nyulangone.org.

2 Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA.

3 Department of Medicine, NYU School of Medicine, New York, NY.

4 Division of Gastroenterology and Hepatology, Department of Medicine, Cleveland Clinic Florida, Weston, FL.

5 Crohn's and Colitis Center at Massachusetts General Hospital, Division of Gastroenterology, Department of Medicine, Harvard Medical School, Boston, MA.

6 Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY.

7 Division of Gastroenterology, Department of Medicine, UT Southwestern Medical Center, Dallas, TX.

8 Division of Gastroenterology, Department of Medicine, Lenox Hill Hospital, New York, NY.

9 Division of Gastroenterology, Department of Medicine, Montefiore Medical Center, New York, NY.

10 Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, New York, NY.

11 Inflammatory Bowel Disease Center at NYU Langone Health, Division of Gastroenterology, Department of Medicine, NYU School of Medicine, New York, NY.

12 Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.

13 Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.

Abstract

BACKGROUND & AIMS: Exposure to hormone contraception has been associated with an increased risk of relapse of inflammatory bowel diseases (IBD). Little is known about the effects of cancer therapies, specifically hormone therapies, on the course of IBD.

METHODS: We conducted a retrospective cohort study, collecting data from 5 medical centers on patients with IBD who received a subsequent diagnosis of breast or prostate cancer from 1997 through 2018. For patients with quiescent IBD at their cancer diagnosis, the primary outcome was relapse of IBD. For patients with active IBD at their cancer diagnosis, the primary outcome was IBD remission.

RESULTS: Our analysis included 447 patients with IBD (44% with Crohn's disease, 53% with ulcerative colitis, and 3% with IBD-unclassified) who had either breast (78%) or prostate (22%) cancer. At their cancer diagnosis, 400 patients (90%) had inactive IBD, and 47 (10%) had active IBD. Among patients with inactive IBD, 112 (28%) developed active IBD. Previous exposure to steroids, immunomodulators, or biologics was associated with IBD relapse following a cancer diagnosis (hazard ratio [HR] for steroids, 1.79; 95% CI, 1.18-2.71; HR for immunomodulators, 2.22; 95% CI, 1.38-3.55; HR for biologics, 1.95; 95% CI, 1.01-5.36). Hormone monotherapy (HR, 2.00; 95% CI, 1.21-3.29) and combination cytotoxic and hormone therapy (HR, 1.86; 95% CI, 1.01-3.43) was associated with IBD relapse. Among 34 patients who received only cytotoxic chemotherapy, 75% remained in remission from IBD at 250 months compared with 42% of those who received hormone monotherapy (log rank=0.02). Among patients with active IBD at their cancer diagnosis, 14 (30%) entered remission from IBD, but there were no significant factors of achieving IBD remission.

CONCLUSIONS: In a multicenter retrospective study, we found that patients with IBD and breast or prostate cancer who receive hormone therapy have an increased risk for relapse of IBD and related adverse outcomes.