Jordan Axelrad, MD, on Malignancy in IBD

Dr Axelrad delivered a keynote talk at the 2025 AIBD Annual Meeting on dealing with malignancies in patients with IBD, including those caused by long-standing inflammation and those that may be attributable to some medications for inflammatory bowel disease.

Jordan Axelrad, MD, is an associate professor of medicine at the NYU Grossman School of Medicine and codirector of the Inflammatory Bowel Disease Center at NYU Langone Health in New York City. 

TRANSCRIPT:

I am Jordan Axelrad, codirector of the Inflammatory Bowel Disease Center at NYU Langone Health and an associate professor of medicine at NYU Grossman School of Medicine. And at this year's AIBD I spoke on malignancies in IBD.

When we think of cancer risk in our patients with IBD, we tend to divide these into two major categories—those due to underlying IBD or chronic intestinal inflammation, and those malignancies include, of course, colorectal cancer, small bowel adenocarcinoma, intestinal lymphoma, anal cancers, and in patients with PSC, cholangiocarcinoma; and potentially IBD therapy associated cancers, which may include lymphoma, nonmelanoma skin cancers, genitourinary cancers, and melanoma.

And so when we think about these risks of cancer due to IBD therapies, the large risk is generally driven actually by thiopurines. And in patients exposed to thiopurine, there is a clear association with lymphoma risk. That risk of lymphoma with anti-TNF is a little more controversial. We find that in larger studies that the risk of lymphoma does not appear to be closely linked with anti-TNF exposure, but is largely driven by thiopurine exposure for other cancers. Those risks are relatively less defined.

There are emerging data on JAK inhibitors, particularly from our patients with rheumatoid arthritis, that JAK inhibitors may be associated with nonmelanoma skin cancers, lymphoma, lung cancer, and other cancers. But these data have not been replicated in IBD populations.

And then I finished the talk talking about the management of patients with IBD who develop cancer. We have some limited data that certain types of cancer treatments may directly impact the course of IBD, such as cytotoxic therapies that may actually improve underlying IBD, whereas checkpoint inhibitors may be associated with disease exacerbation and that there are also conflicting data on pelvic radiation and more studies are needed.