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Decreased risk of cancer in multiple sclerosis patients and analysis of the effect of disease modifying therapies on cancer risk

  • Deeya Gaindh
    Affiliations
    Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, Buffalo, NY, USA
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  • Katelyn S. Kavak
    Affiliations
    Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, Buffalo, NY, USA

    New York State MS Consortium, University at Buffalo, Buffalo, NY, USA
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  • Barbara Teter
    Affiliations
    Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, Buffalo, NY, USA

    New York State MS Consortium, University at Buffalo, Buffalo, NY, USA

    Department of Neurology, State University of New York at Buffalo, Buffalo, NY, USA
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  • Caila B. Vaughn
    Affiliations
    Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, Buffalo, NY, USA

    New York State MS Consortium, University at Buffalo, Buffalo, NY, USA

    Department of Neurology, State University of New York at Buffalo, Buffalo, NY, USA
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  • Diane Cookfair
    Affiliations
    Department of Neurology, State University of New York at Buffalo, Buffalo, NY, USA
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  • Theresa Hahn
    Affiliations
    Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
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  • Bianca Weinstock-Guttman
    Correspondence
    Corresponding author at: Jacobs Comprehensive MS Treatment and Research Center, 100 High Street, Buffalo, NY 14203, USA.
    Affiliations
    Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, Buffalo, NY, USA

    New York State MS Consortium, University at Buffalo, Buffalo, NY, USA

    Department of Neurology, State University of New York at Buffalo, Buffalo, NY, USA
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  • on behalf of the New York State Multiple Sclerosis Consortium
    Author Footnotes
    1 See acknowledgements for a list of participating NYSMSC investigators.
  • Author Footnotes
    1 See acknowledgements for a list of participating NYSMSC investigators.
Published:September 09, 2016DOI:https://doi.org/10.1016/j.jns.2016.09.005

      Highlights

      • Assessed cancer in MS patients, family history, among DMT users and naïve patients
      • Prevalence of cancer in males and females in NYSMSC cohort was lower than expected.
      • MS patients with history of cancer more likely to report DMT use

      Abstract

      Background

      Although dysimmunity is considered an important link between multiple sclerosis (MS), family history and cancer risk, their relationship to the use of disease modifying therapies (DMT) is not fully understood.

      Objective

      To assess the observed versus expected number of cancers in MS patients, and family history of cancer, among DMT users and DMT naïve patients.

      Methods

      Cancer, DMT use, and family history of cancer were assessed using the New York State Multiple Sclerosis Consortium (NYSMSC) registry. Self-reported cancers in MS patients were tested for associations with DMT use, family history of cancer and other factors. Expected number of cancer cases was estimated using age- and gender-specific prevalence and incidence rates from the general population.

      Results

      The prevalence of cancer in males and females in the NYSMSC cohort was lower than expected (p < 0.001). Patients with cancer were older at MS diagnosis and more likely to be female (p < 0.001). MS patients with a personal history of cancer were more likely to report DMT use (p < 0.001) and family history of cancer (p < 0.001). Multivariable analysis did not support a higher risk of cancer after DMT initiation.

      Conclusions

      We report a lower than expected number of cancer cases in MS patients compared to the general population. MS patients with a personal history of cancer were more likely to report DMT use suggesting that DMTs may abrogate the lower incidence of cancer in MS.

      Keywords

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      References

        • Office of Communications and Public Liaison
        National Institute of Neurological Disorders and Stroke. Multiple Sclerosis: Hope through Research.
        National Institutes of Health, 2014
        • Handel A.E.
        • Ramagopalan S.V.
        Multiple sclerosis and risk of cancer: a meta-analysis.
        J. Neurol. Neurosurg. Psychiatry. 2010; 81: 1413-1414
        • Midgard R.
        • Glattre E.
        • Gronning M.
        • Riise T.
        • Edland A.
        • Nyland H.
        Multiple sclerosis and cancer in Norway. A retrospective cohort study.
        Acta Neurol. Scand. 1996; 93: 411-415
        • Moller H.
        • Kneller R.W.
        • Boice Jr., J.D.
        • Olsen J.H.
        Cancer incidence following hospitalization for multiple sclerosis in Denmark.
        Acta Neurol. Scand. 1991; 84: 214-220
        • Seda I.M.
        • Zubair A.
        • Brewer J.D.
        Cutaneous malignancies in immunosuppressed organ transplant recipients.
        Skinmed. 2014; 12: 164-173
        • Penn I.
        • Starzl T.E.
        Immunosuppression and cancer.
        Transplant. Proc. 1973; 5: 943-947
        • Penn I.
        Depressed immunity and the development of cancer.
        Clin. Exp. Immunol. 1981; 46: 459-474
        • Levine A.M.
        AIDS-related malignancies: the emerging epidemic.
        J. Natl. Cancer Inst. 1993; 85: 1382-1397
        • Cools N.
        • Ponsaerts P.
        • Van Tendeloo V.F.
        • Berneman Z.N.
        Regulatory T cells and human disease.
        Clin. Dev. Immunol. 2007; 2007: 89195
        • Woo E.Y.
        • Chu C.S.
        • Goletz T.J.
        • et al.
        Regulatory CD4(+)CD25(+) T cells in tumors from patients with early-stage non-small cell lung cancer and late-stage ovarian cancer.
        Cancer Res. 2001; 61: 4766-4772
        • Ormandy L.A.
        • Hillemann T.
        • Wedemeyer H.
        • Manns M.P.
        • Greten T.F.
        • Korangy F.
        Increased populations of regulatory T cells in peripheral blood of patients with hepatocellular carcinoma.
        Cancer Res. 2005; 65: 2457-2464
        • Kono K.
        • Kawaida H.
        • Takahashi A.
        • et al.
        CD4(+)CD25 high regulatory T cells increase with tumor stage in patients with gastric and esophageal cancers.
        Cancer Immunol. Immunother. 2006; 55: 1064-1071
        • Zou W.
        Immunosuppressive networks in the tumour environment and their therapeutic relevance.
        Nat. Rev. Cancer. 2005; 5: 263-274
        • Lebrun C.
        • Vermersch P.
        • Brassat D.
        • et al.
        Cancer and multiple sclerosis in the era of disease-modifying treatments.
        J. Neurol. 2011; 258: 1304-1311
        • Sadovnick A.D.
        • Ebers G.C.
        • Dyment D.A.
        • Risch N.J.
        Evidence for genetic basis of multiple sclerosis. The Canadian collaborative study group.
        Lancet. 1996; 347: 1728-1730
        • Alonso A.
        • Hernan M.A.
        • Ascherio A.
        Allergy, family history of autoimmune diseases, and the risk of multiple sclerosis.
        Acta Neurol. Scand. 2008; 117: 15-20
        • Holzmann C.
        • Bauer I.
        • Meyer P.
        Co-occurrence of multiple sclerosis and cancer in a BRCA1 positive family.
        Eur. J. Med. Genet. 2013; 56: 577-579
        • Bahmanyar S.
        • Montgomery S.M.
        • Hillert J.
        • Ekbom A.
        • Olsson T.
        Cancer risk among patients with multiple sclerosis and their parents.
        Neurology. 2009; 72: 1170-1177
        • Surveillance Epidemiology and End Results Program
        Prevalence database: “US estimated complete prevalence counts on 1/1/2012”.
        National Cancer Institute. DCCPS. Surveillance Research Program. Data Modeling Branch, 2015 (released April 2015, based on November 2014 SEER data submission)
        • Jacobs L.D.
        • Wende K.E.
        • Brownscheidle C.M.
        • et al.
        A profile of multiple sclerosis: the New York state multiple sclerosis consortium.
        Mult. Scler. 1999; 5: 369-376
        • Surveillance Epidemiology and End Results Program
        Incidence database: US age-specific SEER incidence rates, by race and sex, 2008–2012.
        National Cancer Institute. DCCPS. Surveillance Research Program. Data Modeling Branch, 2015 (Released April 2015, based on November 2014 SEER data submission)
        • Johnson D.B.
        • Peng C.
        • Sosman J.A.
        Nivolumab in melanoma: latest evidence and clinical potential.
        Ther. Adv. Med. Oncol. 2015; 7: 97-106
        • Sharma P.
        • Allison J.P.
        The future of immune checkpoint therapy.
        Science. 2015; 348: 56-61
        • Hartung H.P.
        • Bar-Or A.
        • Zoukos Y.
        What do we know about the mechanism of action of disease-modifying treatments in MS?.
        J. Neurol. 2004; 251: v12-v29
        • Kingwell E.
        • Bajdik C.
        • Phillips N.
        • et al.
        Cancer risk in multiple sclerosis: findings from British Columbia, Canada.
        Brain. 2012; 135: 2973-2979
        • Noyes K.
        • Weinstock-Guttman B.
        Impact of diagnosis and early treatment on the course of multiple sclerosis.
        Am. J. Manag. Care. 2013; 19: s321-s331
        • Roshanisefat H.
        • Bahmanyar S.
        • Hillert J.
        • Olsson T.
        • Montgomery S.
        All-cause mortality following a cancer diagnosis amongst multiple sclerosis patients: a Swedish population-based cohort study.
        Eur. J. Neurol. 2015; 22: 1074-1080
        • Jick S.
        • Li L.
        • Falcone G.
        • Vassilev Z.
        • Wallander M.-A.
        Mortality of patients with multiple sclerosis: a cohort study in UK primary care.
        J. Neurol. 2014; 261: 1508-1517
        • Franks A.L.
        • Slansky J.E.
        Multiple associations between a broad spectrum of autoimmune diseases, chronic inflammatory diseases and cancer.
        Anticancer Res. 2012; 32: 1119-1136