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Crohn's Disease Forum » Treatment » Cimzia/Certolizumab » Cimzia with history of cancer


01-14-2011, 03:45 PM   #1
chrisnsteph1022
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Cimzia with history of cancer

I read that Cimzia can cause cancer. Is it contraindicated for people with a history of cancer? Mine was very minor (melanoma in situ x2, basal cell carcinoma x4). No chemo or radiation. Just cut it out and I was fine. But since it seems that I'm prone to skin cancers (thanks to my stupid habit of tanning beds), could I have more problems with Cimzia? I'm supposed to start it next week, I believe.
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Stephanie
dx 2003
Remission 2004-2010
Moderate/severe flare through entire colon 12/2010-10/2012
Lialda, omeprazole, Remicade, Methotrexate, Folic Acid, Questran
Been on Asacol, prednisone, Apriso, Imuran, Entocort and Cimzia
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01-14-2011, 09:14 PM   #2
David in Seattle
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I read that Cimzia can cause cancer. Is it contraindicated for people with a history of cancer? Mine was very minor (melanoma in situ x2, basal cell carcinoma x4). No chemo or radiation. Just cut it out and I was fine. But since it seems that I'm prone to skin cancers (thanks to my stupid habit of tanning beds), could I have more problems with Cimzia? I'm supposed to start it next week, I believe.
Stephanie - The product labeling for Cimzia states the following regarding cancer:

"In the controlled portions of clinical studies of some TNF blockers, more cases of malignancies have been observed among patients receiving TNF blockers compared to control patients. During controlled and open-labeled portions of CIMZIA studies of Crohn's disease and other diseases, malignancies (excluding non-melanoma skin cancer) were observed at a rate (95% confidence interval) of 0.5 (0.4, 0.7) per 100 patient-years among 4,650 CIMZIA-treated patients versus a rate of 0.6 (0.1, 1.7) per 100 patient-years among 1,319 placebo-treated patients. The size of the control group and limited duration of the controlled portions of the studies precludes the ability to draw firm conclusions.

Malignancies, some fatal, have been reported among children, adolescents, and young adults who received treatment with TNF-blocking agents (initiation of therapy ≤ 18 years of age), of which CIMZIA is a member. Approximately half the cases were lymphomas, including Hodgkin's and non-Hodgkin's lymphoma. The other cases represented a variety of different malignancies and included rare malignancies usually associated with immunosuppression and malignancies that are not usually observed in children and adolescents. The malignancies occurred after a median of 30 months of therapy (range 1 to 84 months). Most of the patients were receiving concomitant immunosuppressants. These cases were reported post-marketing and are derived from a variety of sources including registries and spontaneous post-marketing reports.

In the controlled portions of clinical trials of all the TNF blockers, more cases of lymphoma have been observed among patients receiving TNF blockers compared to control patients. In controlled studies of CIMZIA for Crohn's disease and other investigational uses, there was one case of lymphoma among 2,657 Cimzia-treated patients and one case of Hodgkin's lymphoma among 1,319 placebo-treated patients.

In the CIMZIA RA clinical trials (placebo-controlled and open label) a total of three cases of lymphoma were observed among 2,367 patients. This is approximately 2-fold higher than expected in the general population. Patients with RA, particularly those with highly active disease, are at a higher risk for the development of lymphoma.

Rates in clinical studies for CIMZIA cannot be compared to the rates of clinical trials of other TNF blockers and may not predict the rates observed when CIMZIA is used in a broader patient population. Patients with Crohn's disease that require chronic exposure to immunosuppressant therapies may be at higher risk than the general population for the development of lymphoma, even in the absence of TNF blocker therapy [see Adverse Reactions (6.1)]. The potential role of TNF blocker therapy in the development of malignancies in adults is not known.

Cases of acute and chronic leukemia have been reported in association with post-marketing TNF-blocker use in RA and other indications. Even in the absence of TNF-blocker therapy, patients with RA may be at a higher risk (approximately 2-fold) than the general population for the development of leukemia.

I think the important portions are "The size of the control group and limited duration of the controlled portions of the studies precludes the ability to draw firm conclusions" and "The potential role of TNF blocker therapy in the development of malignancies in adults is not known".

The Cimzia labeling does not specifically mention a history of cancer as a contraindication.

In addition, there is this from the FDA

Tumor Necrosis Factor (TNF) Blockers (marketed as Remicade, Enbrel, Humira, Cimzia, and Simponi) August 2009

"FDA notified healthcare professionals that it has completed its analysis of tumor necrosis factor (TNF) blockers and has concluded that there is an increased risk of lymphoma and other cancers associated with the use of these drugs in children and adolescents. This new safety information is now being added to the Boxed Warning for these products. FDA has also identified new safety information related to the occurrence of leukemia and new-onset psoriasis in patients treated with TNF blockers. The current prescribing information for TNF blockers does contain a warning for malignancies, but does not specifically mention leukemia. FDA is also requiring updates to the current Medication Guide to help patients understand the risks associated with TNF blocker therapy.

TNF blockers are approved for the treatment of one or more of a number of immune system diseases including juvenile idiopathic arthritis (JIA), rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, Crohn’s disease, and ankylosing spondylitis."

More information can be found at http://www.fda.gov/Drugs/DrugSafety/.../ucm174474.htm

There appears to be an increase in lymphoma in particular associated with TNF agents, especially for children and adolescents, but at this early stage of knowledge of these drugs, the increase is probably small, and it is difficult (again, with the current knowledge) to separate any increases from those associated with the conditions treated with these drugs, such as Crohn's and rheumatoid arthritis. It's impossible to know for certain, of course, whether a history of melanoma & basal cell carcinoma would be likely to increase your risk of developing one of the malignancies primarily associated with TNF's in adults. How old are you? Do you have a family history of lymphoma or leukemia? Are you/will you be using any other immunosuppressive drugs such as azathioprine or methotrexate? Most importantly, have you discussed this with your doctor? What does he or she say?

I'm sure I don't have to tell you that, with your history, it is VITAL that you avoid unnecessary sunlight and ALL tanning beds!

I hope this helps, and again DO bring this up with your doctor, if you haven't already!!!
01-14-2011, 09:18 PM   #3
chrisnsteph1022
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Thanks for the info. It sounds pretty safe with my history. My doc knows I've had skin cancer, but it's never been discussed. I won't be on any other immune suppressants. I'm 30, no history of cancers in the family.
01-15-2011, 03:16 PM   #4
ErikaHouston
 
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I read that Cimzia can cause cancer. Is it contraindicated for people with a history of cancer? Mine was very minor (melanoma in situ x2, basal cell carcinoma x4). No chemo or radiation. Just cut it out and I was fine. But since it seems that I'm prone to skin cancers (thanks to my stupid habit of tanning beds), could I have more problems with Cimzia? I'm supposed to start it next week, I believe.
Unfortunately there are no very good studies for this as all individuals with prior melanomas and/or malignancies are excluded from all of the studies. I also have a previous melanoma diagnosis - Stage I. If your melanomas were in situ you caught them EXTREMELY early (good job!). I am not going on TNF blockers because of this uncertainty....at least for now. The Dr's that follow me for the Melanoma at MD Anderson Cancer Center just feel it's a bit risky as the drugs (especially Cimzia) are so new there is really not a lot of data on them. My GI really wants me to go on Cimzia as well...but for now we are going with Imuran as a compromise.

Good luck -it's a tough decision. I would definitely suggest increasing the frequency of your dermatologist visits while on this.
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3 Hemorhages (July '10, Sept '10, Oct '10) - no other Crohn's symptoms

Diagnosed Oct'10

Currently on Entocort and Apriso and starting Imuran in December '10

History of Melanoma ('08) so avoiding TNF blockers.
05-20-2012, 08:18 AM   #5
Bostonnp
 
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Has any one been diagnosed with lymphoma after taking cimzia? I have had 5 doses and now in the hospital with an obstruction. The ct scan shows new lymph nodes that are worrisome for lymphoma. They dont want to start steroids for fear of masking the cancer. I am scheduled for a ileoressection, and the nodes will be biopsies then. Any comments or info to share?
01-13-2016, 06:17 AM   #6
markmags
 
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This is not mandatory. Alternative medicine experts may help in such situations.
01-13-2016, 08:53 AM   #7
Axelfl3333
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I would definitely go with the Drs advice and if they want to biopsy anything I would allow them to do so even if it's only for peace of mind,who needs that worry on there mind?good luck
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