Therapeutic Management of Adults with Inflammatory Bowel Disease and Malignancies: A Clinical Challenge

SIMPLE SUMMARY: The management and treatment of patients with inflammatory bowel diseases after a diagnosis of malignancy represents a challenge for physicians, since their most common therapy, such as biologics and immunosuppressants, should be discontinued for 2–5 years after the end of cancer treatment. Special situations could be managed using new gut-selective drugs; however, limited data are available for these new therapies. We aim to summarize the current evidence about the reintroduction of different therapies after the primary diagnosis of cancer and to describe the course of inflammatory bowel disease without any immunosuppressive treatment after the diagnosis of cancer. ABSTRACT: Patients with chronic inflammatory bowel diseases (IBD) have increased risk of developing intestinal and extraintestinal cancers. However, once a diagnosis of malignancy is made, the therapeutic management of Crohn’s disease (CD) and ulcerative colitis (UC) can be challenging as major guidelines suggest discontinuing the ongoing immunosuppressant and biological therapies for at least 2–5 years after the end of cancer treatment. Recently, new molecules such as vedolizumab and ustekinumab have been approved for IBD and limited data exist on the real risk of new or recurrent cancer in IBD patients with prior cancer, exposed to immunosuppressants and biologic agents. Thus, a multidisciplinary approach and case-by-case management is the preferred choice. The primary aim of our review was to summarize the current evidence about the safety of reintroducing an immunosuppressant or biologic agent in patients with a history of malignancy and to compare the different available therapies, including gut-selective agents. The secondary aim was to evaluate the clinical course of the IBD patients under cancer treatment who do not receive any specific immunosuppressant treatment after the diagnosis of cancer.