The widespread use of thiopurines and anti-
tumor necrosis factors (TNFs) in
inflammatory bowel disease (IBD) is a rising concern regarding their potential
cancer risk. MEDLINE, EMBASE, and the Cochrane Library database were searched for articles regarding
immunomodulators anti-TNF agents in IBD,
hematologic malignancies, and solid
tumors. Current evidences support that thiopurines and anti-TNFs used alone or in combination do not increase the overall
cancer risk in IBD. Thiopurines use, with or without anti-TNFs, is associated with an increased risk of
lymphoma, particularly
non-Hodgkin lymphoma, in
Crohn's disease. Combined treatment significantly increases the risk of a rare hepatosplenic
T-cell lymphoma, particularly in young male patients with
Crohn's disease. An increased risk of nonmelanotic
skin cancer is also observed when using thiopurines in IBD, whereas a slightly increased risk of
melanoma is observed when using anti-TNFs. The role played by
immunomodulators in the development of other
cancer types (i.e., urinary) as also by the severity of IBD is under investigation. Although the incidence of specific
malignancies (
lymphoma,
skin cancers) seems to be increased by
immunomodulators, their absolute number is low. As thiopurines and anti-TNFs are highly effective in IBD, current evidences support that in appropriate hands, their benefits overwhelm the
cancer risk. However, a careful selection of both patients and timing of treatment is mandatory, particularly in young male patients with
Crohn's disease.
Immunomodulators should therefore be handled by experienced and dedicated gastroenterologists who aware of the potential, although low,
cancer risk associated with their use in patients with IBD.