A new investigation published on May 20, 2020, in JAMA Dermatology found that individuals taking biologics tend to have a slightly higher chance of developing melanoma compared with those treated with conventional systemic therapy, but that risk was not statistically significant. RELATED: Rheumatoid Arthritis Medication: Beware of Sunburn if You Take These Drugs
Findings Are Noteworthy for People With RA, IBD, and Other Conditions
People considering biologic therapy for rheumatoid arthritis, psoriasis, and some types of IBD, such as Crohn’s disease or ulcerative colitis (UC), have noted concerns about their use and a possible link to the potentially deadly skin cancer. “Melanoma is an aggressive skin cancer and of concern to people treated with biologics, as the risk of melanoma increases with suppression of the immune system,” says lead author Shamarke Esse, a researcher in the division of musculoskeletal and dermatological sciences at the University of Manchester in England. “Our study aimed to determine if people with these common inflammatory conditions who are increasingly prescribed these therapies are at an increased risk of melanoma compared with patients with the same conditions treated with conventional systemic therapy only.” RELATED: Does IBD Put You at Risk for Skin Cancer?
The Review Analyzed 7 Studies, But Results Don’t Resolve the Issue
Esse and his colleagues based their results on the analysis of seven studies, comparing the risk of melanoma among 34,000 patients treated with biologics with 135,000 patients treated with conventional systemic therapy for rheumatoid arthritis, psoriasis or inflammatory bowel disease. The biologics in the study included Rituxan (rituximab), Orencia (abatacept), Enbrel (etanercept), Remicade (infliximab), and Humira (adalimumab). The scientists used a statistical method called a proportional reporting ratio to summarize risk. “It is still difficult to translate into absolute numbers, but based on the proportional reporting ratio the melanoma risk was higher in patients receiving placebo, however only 1.2 to 1.5 times higher,” says Elena Schiopu, MD, associate professor of medicine in the division of rheumatology at Michigan Medicine Hospital Systems in Ann Arbor. RELATED: Your COVID-19 Summer Safety Guide
Be on the Alert for Cancer Symptoms
While the numbers were not statistically significant, Dr. Schiopu — who was not involved in the study — cautions that these drugs already have black box warnings regarding possible related malignancies, and patients should be vigilant about a variety of signs and symptoms of cancer. She also notes that conventional systemic therapy, such as (nonbiologic) methotrexate, is not necessarily risk-free when it comes to cancer. “Melanoma has been reported with conventional treatment as well,” says Schiopu. As Everyday Health reported in February 2020, some research has tied methotrexate to a higher risk of skin cancer.
Benefits of Biologics May Outweigh Risks
For Waseem Mir, MD, a rheumatologist with Lenox Hill Hospital in New York City, the study results point to the overall fact that positives of biologics so far appear to outweigh the risks. “The conclusion is there is a little bit of objection but not enough to warrant drastic changes in our treatment approach,” says Dr. Mir, who was not involved in the research. “We have had close to 20 years of experience since the first biologic came out, and since then there have been plenty of studies to figure out the related risks to cancer. We’re treating autoimmune conditions that are so debilitating — they take away functionality and quality of life, so we can’t stop taking these medications based on these results.”
Addressing Cancer Risk Concerns
Mir has had patients on biologics who do get skin cancer but suggests that you cannot know if the cancer developed because of the biologics or the underlying autoimmune condition or some other cause. If cancer is detected in his patients, however, he will in most cases discontinue the use of biologics. Research published in May 2017 in the medical journal Oncologysaid, “The general consensus has been that treatment with all biologics should be held in patients with active malignancy who are undergoing chemotherapy. Nevertheless, a patient’s stage of disease, overall prognosis, concomitant cancer therapy, and individual preferences should be taken into consideration.”
Larger Studies Looking at Melanoma Risks Are Needed
Esse adds that this current study backs up a previous meta-analysis published in July 2018 in Annals of Rheumatic Disease finding no significant increased risk of invasive melanoma in rheumatoid arthritis patients treated with biologics over those receiving conventional systemic therapy. He and his collaborators point out that a major limitation in their analysis was the small number of investigations examined. “The findings suggest that a clinically meaningful increase in melanoma risk cannot be ruled out,” concluded the study authors. “Further studies with large patient numbers that adjust for key risk factors are needed to resolve the issue of long-term safety of biologic therapy.”
