Latest news with #malignancy
Medscape
7 days ago
- Health
- Medscape
Cancer Risk in MMF-Treated Patients Differs by Indication
TOPLINE: Patients with dermatologic conditions showed a 74% lower risk for malignancy with mycophenolate mofetil (MMF) than transplant patients, a study found. METHODOLOGY: Researchers conducted a single-center retrospective chart of patients who had taken MMF for ≥ 5 years between 2012 and 2025 at Atrium Health Wake Forest Baptist Medical Center. The analysis included 126 patients (mean age, 64.2 years; 35.7% men) who received MMF for dermatologic conditions, 226 organ transplant recipients (mean age, 59.6 years; 61.5% men) who received MMF plus other immunosuppressive agents, and 296 patients (mean age, 64.1 year; 34.5% men) with dermatologic conditions who had no exposure to systemic immunosuppression. About two thirds of patients were White individuals and one fourth were Black individuals. Dermatologic patients received a mean daily MMF dose of 1390 mg over an average of 7.5 years, while transplant recipients received a lower mean daily dose of 807 mg for a mean duration of 9.9 years. Concomitant immunosuppressive therapy was administered to 40% of the patients with dermatologic conditions (MMF plus prednisone) and to 100% of transplant recipients (tacrolimus, prednisone, or cyclosporine). Researchers compared malignancy rates between the groups. TAKEAWAY: Overall, 9.5% of the dermatologic patients who received MMF developed malignancies compared with 36% of the transplant recipients (P < .0001); the risk for malignancy was 74% lower in dermatologic patients treated with MMF (95% CI, 0.1487-0.4518). No difference was found between dermatologic patients who received MMF vs those without exposure to systemic immunosuppression (8.4%). Cutaneous malignancies were significantly more common in transplant patients than in dermatologic patients who received MMF (26.5% vs 5.6%; P < .0001). The prevalence of urological/reproductive cancers was higher in transplant patients than dermatologic patients treated with MMF (9.3% vs 2.4%; P = .0143). IN PRACTICE: 'The use of MMF for dermatologic conditions does not appear to expose patients to the same malignancy risk as those treated with MMF and other chronic immunosuppressive treatments in the transplant setting and did not confer an elevated malignancy risk compared to dermatologic patients without systemic immunosuppression,' the authors of the study wrote. SOURCE: The study was led by Robin Yi, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, and was published online on July 17 in the Journal of the American Academy of Dermatology. LIMITATIONS: Limitations included the MMF dosing variability and small sample size. DISCLOSURES: The study did not receive any funding. One author reported receiving research, speaking and consulting support from numerous pharmaceutical companies including Eli Lilly, GlaxoSmithKline/Stiefel, AbbVie, and Janssen and disclosed being founder and part owner of Causa Research and holding stock in Sensal Health. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
28-05-2025
- General
- Medscape
Independent Cancer Risk Predictors ID'd for Sjögren Disease
TOPLINE: Patients with Sjögren disease (SjD) had a 68% higher risk for overall malignancy than the general population, with hematologic malignancies contributing more to this elevated risk than solid tumors. Cancer accounted for 23.8% of deaths, with older age at diagnosis, smoking, lymphadenopathy, splenomegaly, and cryoglobulinemia identified as key predictors. METHODOLOGY: Researchers conducted a prospective study to investigate the risk for cancer among patients with SjD who met the 2002 American-European Consensus Group criteria (n = 314; mean age at inclusion, 66 years; 94.6% women) over a median follow-up of 9.5 years. They collected information at baseline and follow-up on systemic manifestations, serological markers, disease activity scores, and treatment regimens. They calculated standardized incidence ratios (SIRs) to compare the incidence of cancer between the study and the general population. TAKEAWAY: Overall, 7.01% of patients developed malignancies during follow-up; of these, 50% developed hematologic malignancies — all being non-Hodgkin lymphoma — while the remaining 50% developed solid tumors. Patients with SjD had a 68% higher risk of developing cancer than the general population (SIR, 1.68; 95% CI, 1.68-1.69), mainly driven by a higher risk for hematologic malignancies (SIR, 3.55; 95% CI, 3.54-3.56) than for solid tumors (SIR, 1.54; 95% CI, 1.53-1.55). Older age at diagnosis, smoking, lymphadenopathy, splenomegaly, and cryoglobulinemia were independent predictors of malignancy. Of the 42 deaths, cancer was responsible for 23.8% of deaths, with a relative risk of 2.21 for mortality in patients with a history or new diagnosis of cancer. IN PRACTICE: 'These findings underscore the need for early identification of high-risk patients and the refinement of risk prediction models,' the study authors wrote. SOURCE: This study was led by Olga Rusinovich-Lovgach, MD, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain, and was published online on May 4, 2025, in Seminars in Arthritis and Rheumatism. LIMITATIONS: The small number of malignancies reduced statistical power, which may have prevented the evaluation of cancer-specific SIRs. The lack of a non-SjD control group may have limited the ability to differentiate disease-specific risk factors. Additionally, selection bias may be present, as patients recruited from rheumatology clinics likely had more severe disease, potentially not reflecting the broader SjD population. DISCLOSURES: This study received grants or industrial support from the Spanish Society of Rheumatology. One author reported receiving administrative support, article publishing charges, statistical analysis, and other ties with the Spanish Society of Rheumatology. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
09-05-2025
- Health
- Medscape
CT Follow-up Strategy Optimises Lung Cancer Screening
Short-interval CT demonstrated spontaneous resolution of consolidation in more than 50% of lung cancer screening participants, while persistent consolidation showed a 29.8% risk for malignancy. This conservative approach rather than immediate PET-CT could save £47,600 per 10,000 screening CTs. METHODOLOGY: Researchers conducted a retrospective study to assess the safety of a short-term follow-up low-dose CT (LDCT) scan for consolidation in a regional lung cancer screening programme in the United Kingdom. Participants aged 55-74 years who were ever smokers underwent lung health checks and risk assessment, and those meeting specific risk thresholds qualified for an LDCT scan. Overall, 10,247 CT studies from 8778 participants (mean age, 68 years) were analysed; consolidation was detected in 113 participants, and they underwent a 6-week repeat LDCT scan. Study outcomes included the proportion of participants with non-resolving consolidation at 6 weeks, the risk for malignancy at the 6-week follow-up period, and the risk for upstaging over a 6-week delay. Cost savings were estimated on the basis of the National Schedule of National Health Service costs. TAKEAWAY: Among 110 participants who attended a follow-up CT scan, consolidation spontaneously resolved or significantly shrank in 57.3% of participants. Of 47 participants with persistent consolidation, 32 underwent PET-CT imaging, with 13 cases subsequently confirmed as malignant. Among those for whom final outcomes were available, the risk for malignancy in those with indeterminate consolidation on the initial scan was 13.5%, increasing to 29.8% in those with non-resolving consolidation (stage IA, n = 8; stage IB, n = 2; stage IIA, n = 3; and stage IE [lymphoma], n = 1). None of the patients with stage IIA malignancy experienced upstaging during the 6-week follow-up period. A cost analysis revealed potential savings of £47,600 per 10,000 screening CTs through the implementation of short-term interval CT vs immediate PET-CT investigation. IN PRACTICE: "In conclusion, short-interval LDCT imaging for focal indeterminate consolidation in LCS [lung cancer screening] is a cost-effective and safe strategy that reduces unnecessary investigation of inflammatory spontaneously resolving abnormalities. This could be a reasonable approach in a national screening programme, thereby reducing costs of investigation whilst ensuring appropriate follow-up of indeterminate consolidation," the authors wrote. SOURCE: This study was led by Emily C. Bartlett, Department of Radiology, Royal Brompton Hospital, London, England. It was published online on May 02, 2025, in European Radiology . LIMITATIONS: The evaluation of indeterminate focal consolidation warranting a 6-week CT scan was based on the judgement of the reporting radiologist, which may have varied according to reader expertise and judgement. Long-term outcomes were unknown for some participants who attended the 6-week follow-up scan, limiting the completeness of the data. Additionally, the results did not apply to consolidation identified at 3-month nodule follow-up CT, which was not evaluated in this study, nor to clearly mass-like or lobar consolidation. DISCLOSURES: This study did not receive any specific funding . Several authors reported receiving speaker or consulting fees and having other ties with various sources.
