Long-term TNF alpha inhibitor use linked with decreased risk of prostate cancer

In this video, Conor Driscoll, MD, discusses the background and notable findings from the study, “Long-term tumor necrosis factor-alpha inhibitor use decreases the risk of prostate cancer,” which was presented at the American Urological Association 2023 Annual Meeting in Chicago, Illinois. Driscoll is a urology resident at Northwestern University Feinberg School of Medicine in Chicago.

Transcription:

Please describe the background for this study.

Tumor necrosis factor alpha inhibitors have become very wide-ranging medications. They're FDA approved for a variety of chronic inflammatory conditions, the biggest ones being Crohn's disease, ulcerative colitis, rheumatoid arthritis, psoriasis. Adalimumab is one of the main TNF alpha inhibitors. And it's been the most profitable drug in the world for a decent amount of the past decade. It's a very popular drug, and it's an immunosuppressive drug. And so we were seeing a lot of patients on these drugs showing up to the clinic with prostate cancer. Dr. Kundu's idea was, is this immunosuppression leading to these new cancer diagnoses? There's been some literature in the transplant field, talking about how their chronic immunosuppression post transplant has led to an increase in certain types of malignancies. That was the impetus for it, given these are very popular drugs these days.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

We're in the process of publishing the original meta analysis now, but we wanted to see, what is out there? Can we do a more updated and more comprehensive version of it? We did a huge literature review. We started off with 16,000 articles, manually got it down to 45 interventional studies and 10 observational studies. The meta analysis is still limited by follow-up; it's only based on the studies that are out there. And so the meta analysis itself didn't really show anything statistically significant. But we performed this institutional cohort here at the whole Northwestern Medicine system, which is a pretty wide-ranging system here in Illinois. And that actually is where we found all these signals, when we were going manually, patient by patient, looking for these cancer diagnoses. And we found there were 4 types of malignancies that had increased risk. It was kidney cancer, melanoma, non Hodgkins lymphoma, and basal cell carcinoma. Prostate cancer showed a decreased risk, which we thought was very interesting, because it was the only cancer for which that signal existed, that there is possibly a protective effect of these medications. We found that very interesting, and we continue to do some work on that. Prostate cancer is a unique cancer in that it can be indolent for a while; there are some really low-level prostate cancers, where we talk about, what's the 10-year life expectancy for this patient? Will they die of something else before they die of prostate cancer? And then there's very aggressive prostate cancers that metastasize to the bone very quickly. And so there's a huge range of what prostate cancer means, which is why we wanted to do this further analysis, which is the data that I presented at AUA looking at what grade group of prostate cancer was being diagnosed? What was the PSA at diagnosis, because that's typically how at least primary care providers screen for prostate cancer. Those are all the questions we wanted to answer looking into the prostate cancer data.

This transcript was edited for clarity.