MILWAUKEE, WI – The risk of a range of malignancies is increased by chronic inflammation from underlying autoimmune diseases. Furthermore, immunosuppression from treatment often further raises the risk.
One malignancy that appears to increase with autoimmune disease is pancreatic ductal adenocarcinoma (PDAC), according to research available at the 2021 American Society of Clinical Oncology (ASCO) annual meeting.1
Researchers from the Medical College of Wisconsin, Clement J. Zablocki VAMC, both in Milwaukee, and the Cleveland Clinic pointed out that little cancer-specific outcome data is available for those patients. To better understand the risks, the study team retrospectively reviewed the outcomes of patients with PDAC and autoimmune diseases including Crohn’s disease (CD), ulcerative colitis (UC) and rheumatoid arthritis (RA).
The focus was on adult patients with CD, UC and RA who were diagnosed with PDAC between January 2010 and December 2019. Ultimately, 51 patients – median age of 55.2 and 49% male — met inclusion criteria; 26 (51%) had RA, 15 (29.4%) had UC and 10 (19.6%) had CD.
Researchers advised that median duration from diagnosis of AID to PDAC for patients with CD, RA and UC was 173, 107 and 105 months, respectively. Metastatic disease at diagnosis was present in about a third, 37.3%, of the patients, while 62.7% had localized disease (LD).
Among the 17 patients with localized disease who underwent surgery, 6 (35.3%) experienced relapse with a median relapse-free survival of 14 months. The median overall survival of those patients with localized disease who underwent surgery was 44 months compared to 8.25 months for those who did not.
Among the 19 patients with metastatic disease at diagnosis, 0, 1, 2 & 3 lines of chemotherapy were received by 4 (21.1%), 8 (78.9%), 3 (36.8%) and 2 (21.1%) of patients, respectively. The study team reported that median overall survival of patients with metastatic disease at diagnosis was 8.9 months.
“The inflammatory milieu and immunosuppression associated with AID treatment may be responsible for the early onset of PDAC in these patients,” the authors wrote. “Although our sample size is small, patients with AID and PDAC who complete all planned curative intent therapy appear to have excellent outcomes, emphasizing the importance of early diagnosis and perhaps routine screening in patients with AID. Receipt of chemotherapy and OS of patients with metastatic PDAC in the setting of AID does not appear to be significantly compromised despite their exclusion from several clinical trials.”
- Ahmed G, Annunzio K, Szabo, A, Eastwood D. (June 4-8, 2021). Clinical outcomes in pancreatic ductal adenocarcinoma (PDAC) patients with underlying autoimmune disease (AID). ASCO 2021 annual meeting. Virtual.https://meetinglibrary.asco.org/record/199293/abstract