P-074 YI Chemotherapy Tolerance and Oncologic Outcomes in Patients with Inflammatory Bowel Disease and Gastrointestinal Malignancy. (March 2016)

• Record Type: Journal Article
• Authors: Axelrad, Jordan; Itzkowitz, Steven; Colombel, Jean-Frédéric; Harpaz, Noam; Holcombe, Randall; Ozbek, 4, Umut; Ang, Celina
• Is Part Of: Inflammatory bowel diseases. Volume 22(2016:Mar.)Supplement 1
• Publication Date: 2016-03
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1097/01.MIB.0000480244.69491.e4
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract : Background: Inflammatory bowel disease (IBD) is an established risk factor for the development of gastrointestinal (GI) malignancies. Chemotherapy toxicities may compound existing GI tract inflammation and vice versa, raising concerns about the ability of patients with IBD and cancer to tolerate chemotherapy. Although existing studies have demonstrated an effect of cancer treatment on the course of IBD, little is known regarding chemotherapy tolerance and oncologic outcomes in patients with IBD who developed GI malignancies. Methods: We reviewed the medical records of patients with IBD who were treated for a GI malignancy between 2008 and 2013 at The Mount Sinai Hospital, New York. We examined IBD and cancer demographics, chemotherapy treatments and tolerance, cancer recurrence, and survival. Results: We identified 109 patients with IBD (n = 46 [42%] CD; n = 63 [58%] UC) who developed a GI malignancy: 69 (63%) colon adenocarcinoma; 18 (17%) rectal adenocarcinoma, 10 (9%) small bowel adenocarcinoma; 9 (8%) anal squamous cell carcinoma; 2 (2%) appendiceal carcinoid; and 1 (1%) rectal squamous cell carcinoma. At cancer diagnosis, median age was 57 years (range 24–92) and median duration of IBD was 25 years (range 1–59). Of patients with known pathology, cancer stage at diagnosis was 1, 2, 3, 4 in 31 (32%), 26 (27%) 26 (27%), and 14 (14%). Sixty-nine patients (73%) had active IBD on pathology at the time of cancer diagnosis, 52 (75%) of whom had colorectal cancer. Of patients with known cancer treatment plans, 87 (90%) underwent surgery, 62 (71%) received chemotherapy, and 24 (38%) received radiotherapy. Among patients who received chemotherapy, 7 (11%) required dose modifications, 8 (12%) experienced treatment delays; 9 (15%) required treatment discontinuation for an overall treatment modification rate of 13%. Eight (13%) were hospitalized for treatment-related toxicities. Of patients with treatment modification or hospitalization for treatment-related toxicities, 67% had active IBD at cancer diagnosis. Median follow up after cancer diagnosis was 21 months (range 1–121 months) and 21 (27%) developed cancer recurrence. The difference in 5-year recurrence-free survival in patients with stage 1 (89%) compared to stage 2 and 3 (54%) cancers was borderline significant ( P = 0.05). There was no difference in overall survival between patients with stage 1 (88%) versus stage 2 and 3 (78%) cancers ( P > 0.05). Conclusions: In this series, most IBD patients with GI malignancies received and completed chemotherapy uneventfully. The incidence of cancer treatment discontinuations and complications is comparable to that reported in the literature. However, active IBD at cancer diagnosis may be a risk factor for cancer treatment modification and hospitalization for treatment-related toxicities. Prospective studies are needed to further assess the relationship between IBD, chemotherapy tolerance, and overall survival.