Myth: Biologics Cause Cancer
Biologics generally are safe and well-tolerated therapies; however, due to their immunosuppressive properties, the risk for lymphoma has been of potential concern, leading patients to believe that biologics cause cancer. The risk of some cancers, including some solid cancers, hematologic cancers, and skin cancers, appears to be increased in patients with psoriasis, possibly associated with chronic inflammation. Some psoriasis therapies may increase the risk for malignancy, including phototherapy with psoralen plus UVA, cyclosporine, and methotrexate.
Many studies have supported a favorable safety profile for biologics in terms of the risk for developing malignancy. In a 2015 analysis of 12,093 patients enrolled in PSOLAR (Psoriasis Longitudinal Assessment and Registry), none of the biologics were found to be associated with increased risk for malignancy.
In psoriasis patients with existing or prior malignancies, the benefits of biologic therapy to improve quality of life often outweigh the negligible risks for malignancy. However, coordinated care with oncology is recommended for psoriasis patients with a history of prior malignancy.
General recommendations from the American Academy of Dermatology indicate one should carefully consider the decision to use a tumor necrosis factor (TNF) antagonist in patients with a history of malignancy, particularly lymphoma. Short-term treatment with biologics (up to 4 years) appears to be safe with respect to lymphoma risk, especially with TNF-α inhibitors. The potential risk for melanoma, cutaneous T-cell lymphoma, and nonmelanoma skin cancer in patients treated with TNF inhibitors also has been raised.
Expert Commentary
OBSERVE-5 was a 5-year phase 4, prospective, multicenter surveillance registry of 2510 psoriasis patients with at least a baseline dose of etanercept (Kimball et al, 2015). There was no increased risk for cancer when compared to the Truven Health MarketScan database, which is a proxy for the general population.
ESPRIT is an ongoing, 10-year, international, prospective, observational registry of 6059 psoriasis patients with at least a baseline dose of adalimumab (Menter et al). There are no signals of increased risk for cancer.
We do not have enough numbers of psoriasis patients on secukinumab or ixekizumab yet, but their phase 3 trials also do not seem to indicate an increased risk for cancer.
—Jashin J. Wu, MD (Los Angeles, California)