Crohns disease treatment Puts LC in remission!!

[RandyW]

Case Points to Link Between Crohn's Treatment, Cancer

By Steven Reinberg

HealthDay Reporter

Wednesday, July 16, 2008; 12:00 AM

WEDNESDAY, July 16 (HealthDay News) -- An unusual case involving a sudden remission of lung cancer highlights the carcinogenic potential of certain drugs used to treat Crohn's disease, experts say.

The patient, a 69-year-old female ex-smoker, developed lung cancer while being treated with anti-tumor necrosis factor (TNF) medications for her Crohn's disease.

However, the malignancy vanished after doctors stopped giving her the medications, British researchers report in the July 17 issue of theNew England Journal of Medicine.

"There is an underlying concern about the use of these drugs and the possible increase of certain kinds of cancer," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. "This report raises the awareness that doctors and patients have to have in using these drugs. We certainly need to be more vigilant about lung cancer in patients who get these treatments."

The rare case has broader implications and sheds light on the possible effect of anti-TNF medications -- which are also used to treat rheumatoid arthritis -- on patients' immune systems, the team say. This family of biologic drugs includes adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade).

One theory is that the woman, who had been a heavy smoker for 35 years, had had her lung cancer held at bay by her immune system. However, the anti-TNF drugs she was taking for her Crohn's may have weakened that system, allowing the lung cancer to emerge, the researchers say.

The woman's lung malignancy "was expected to be fatal within months," said co-author Jack Satsangi, a professor of gastroenterology at the University of Edinburgh in Scotland. "However, on stopping anti-TNF agents the cancer has completely regressed - and she is healthy more than two years later," he said.

The woman had been diagnosed with lung disease (not cancer) in 1999. In 2000, she was diagnosed with Crohn's disease, which was then treated with TNF medications -- first Remicade, then Humira. In 2006, she was diagnosed with lung cancer.

Her physicians discontinued treatment with Humira, but continued on methotrexate, which is from another class of drugs. The woman did not undergo surgery for her cancer or receive radiation or chemotherapy. In addition, no other biologic drugs were given to treat her lung cancer, the researchers report.

Even so, by April 2007 a scan of her lungs found no trace of the cancer.

"This is most remarkable, and adds to the concerns regarding the use of these agents, and we do not use these drugs in patients with heavy smoking histories," Satsangi said.

The association of TNF medications with lung cancer has been seen before, the authors note. The development of lung cancer among people taking these medications is particularly worrisome among ex-smokers. In fact, Satsangi's group has seen three such cases among people older than 65.

Satsangi's team believes that ex-smokers and people with a history of lung disease taking these medications should be carefully monitored, especially those aged 65 and older.

Lichtenfeld agreed that there have been concerns about the use of these drugs and the development of cancers, particularly lymphoma.

The new report implies that the woman's immune system was keeping the lung cancer in check, but that anti-TNF treatment interfered with her immune response, allowing the cancer to become evident, Lichtenfeld said. "[but] when the drug was withdrawn, the body's native mechanism was re-energized and was able to put this cancer into remission," he explained.

Whether this finding applies to all people taking anti-TNF medications isn't clear, Lichtenfeld added. "Will all patients who received this medication, when it is withdrawn, see their lung cancers go away? I don't think you can draw that conclusion from this report," he said.

"Unusual case reports have been a feature of medicine for a long time," Lichtenfeld said, and whether or not this report has implications for understanding and treating cancer generally remains uncertain. "However, I am sure this report will spark discussion about those questions," he said.

More information

There's more on biologic drugs at the American College of Rheumatology.

SOURCES: Jack Satsangi, D.Phil., professor, gastroenterology, University of Edinburgh, Scotland; Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society, Atlanta; July 17, 2008,New England Journal of Medicine

© 2008 Scout News LLC. All rights reserved.

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[RandyW]

Another story on same person just explains things a little more...

Cancer patient's recovery amazes doctors

« Previous « PreviousNext » Next »View GalleryA LUNG cancer patient in Edinburgh who was given just a few months to live has stunned doctors by going into remission.

The unnamed patient, a 69-year-old female ex-smoker from the Lothians, developed lung cancer in 2006. She also suffered from Crohn's Disease, an unrelated disorder which causes an uncomfortable inflammation of the bowel, and doctors suggested removinADVERTISEMENTg her Crohn's medication while treating the cancer.

Within six months the cancer had unexpectedly disappeared, leading doctors to conclude that the withdrawal of the drug must have been the cause. Edinburgh Royal Infirmary pathologist Dr William Wallace, the lung cancer specialist who conducted the woman's biopsies, said the chances of the cancer going into remission spontaneously were "so astronomical as to be almost nonexistent".

Dr Janet Ironside, consultant clinical oncologist at the Western General, meanwhile called the woman's case "exceptional".

However, Dr Wallace said there was little chance that their findings could be used to formulate a new cure for cancer.

He added: "The Crohn's drug she was taking suppresses the immune system in order to calm the inflammation. When the drug was removed, the woman's immune system would have kicked in and we believe this may have led to the cancer going into remission.

"However, scientist have tried injecting the proteins that cause the immune response into cancer cells with very little response. As a result, it is likely that this case will become little more than a medical curiosity."

While the case may not be able to help towards a cure for cancer, it may lead to further guidelines to prevent it in future.

The Edinburgh experts have written to the New England Journal of Medicine warning that there is now "real concern" over the risk of cancer associated with the woman's medication, known as anti-TNFs.

Professor Jack Satsangi, professor of gastroenterology at the University of Edinburgh, said: "The last thing we want to do is cause a scare so it's important that these findings are discussed in context.

"Crohn's disease is very serious disorder and these drugs can have life-changing effects for their users, so it will be up to doctors and patients to balance the benefits with any newly-identified risks associated with the drugs."

The full article contains 377 words and appears in Edinburgh Evening News newspaper.

[CaroleHammett]

Hey, Randy!

Which came first, the chicken or the egg?

Affectionately,

Carole

Life is not measured by the number of breaths we take, but by the moments that take our breath away.--George Carlin

[Barb73]

Hi Randy,

I tend to believe that the paragraph quoted below gives the clue.

Of course, it may not be the answer, but seems so to me. The reason seems compelling due to the fact that some newer therapeutic vaccines have been shown to hold cancer at bay in some people.

Also, there has been evidence of stress being a factor in a lower immune response, and a succumbing to disease/inflammation.

It was an interesting article.

Barbara

. . . . . . . . .

One theory is that the woman, who had been a heavy smoker for 35 years, had had her lung cancer held at bay by her immune system. However, the anti-TNF drugs she was taking for her Crohn's may have weakened that system, allowing the lung cancer to emerge, the researchers say.

. . . . . . . . .

(HealthDay News, July 16, 2008)

[CaroleHammett]

The theory that I would "like" to believe is that (a) she had Chron's disease, which was being treated; ( during wihch time, she developed lung cancer (separately and independently of the Chron's disease); © the treatment for the Chron's disease affected her immune response; (d) withdrawal of the Chron's disease treatment activated her immune response; and (e) this in turn, attacked her lung cancer cells.

If my "preferred theory" is true, she would have developed the lung cancer no matter what, and eventually died of it, if not for the Chron's disease treatment.

Note that they do not tell us what happened to her Chron's disease (symptoms, advancement, etc.) during the period following her ceasing treatment. Lots more info missing, too, but it seems to me that when you put together everything that we are told, possibly due only to the dearth of information, we are still left with the "Which came first, the chicken or the egg?" question.

Affectionately,

Carole

PS If the above makes no sense, let me know and I'll consider a brain MRI!

[RandyW]

The unnamed patient, a 69-year-old female ex-smoker from the Lothians, developed lung cancer in 2006. She also suffered from Crohn's Disease, an unrelated disorder which causes an uncomfortable inflammation of the bowel, and doctors suggested removinADVERTISEMENTg her Crohn's medication while treating the cancer.

SHe had the Crohns then developed Lung Cancer. when the crohns treatment was removed it forced the immune system to work harder si how I understand this arrticle..

[CaroleHammett]

Hi, Randy.

I agree that your understanding is how it was presented to the New England Journal of Medicine. I was just wondering if it wasn't possible that other explanations for this series of events (or even a different order in the series of events) might be possible, such as the lung cancer happening independently of the treatment for Crohn's.

I also found it interesting that both articles stated that her Crohn's meds were withdrawn so that she could be treated for the lung cancer, yet also stated that she had neither chemo nor radiation therapy. A third article I found on the net stated she was Stage 4 and only given a few months to live, which indicates to me that it must have been an extremely fast-growing cancer since she already had lung disease and presumably if it had been slow or normal in growth, they'd have found it a lot earlier?

I also executed a search of our message boards for Crohn's disease and found one member had it at the time of her '03 lung cancer dx (Fay Aguilar (Fay A.), who died in Aug '06. So far as I can tell, she did not ever disclose what treatment she was on for Crohn's disease.

I also found an interesting 09/03 article posted here re TNF (mentions Crohn's) vs. TM in respect to inflammation and fibrosis:

http://lungevity.org/l_community/viewtopic.php?t=3467&highlight=crohns

Carole

PS Don't even ask why I got off on this subject (let alone why now, since Barb first posted this news back on the 17th, at which time I ignored it! ). Also, now I'm wondering what happened to TM (since I have radiation pneumonitis and the accompanying inflammation/fibrosis).