世界范围内恶性肿瘤有增加的趋势。改善疾病的抗风湿药(DMARDs)是治疗免疫介导的炎性疾病(IMID)的基石,但恶性肿瘤的风险是接受DMARDs的患者的主要关注点.此外,许多IMID已经具有较高的肿瘤背景风险。最近,Janus激酶抑制剂增加了恶性肿瘤的黑匣子警告.此外,在确定的恶性肿瘤患者中使用生物DMARDs通常是不鼓励的,因为在关键研究中排除了此类患者,因此,缺乏证据。相比之下,据报道,一些常规合成DMARDs(csDMARDs)具有抗肿瘤特性,对癌症患者有益.在csDMARD中,氯喹和羟氯喹是研究最广泛的,甲氨蝶呤是一种公认的化疗药物。甚至环孢菌素A,一种众所周知的与癌症风险相关的药物,可以增强一些化疗药物的作用。我们回顾了csDMARDs抗肿瘤活性背后的可能机制和临床证据,包括氯喹和羟氯喹,环孢菌素,来氟米特,霉酚酸酯,霉酚酸,甲氨蝶呤,柳氮磺胺吡啶,和硫嘌呤。这些知识可以指导医生为患有IMID和恶性肿瘤的患者选择csDMARD。
There is an increasing trend of malignancy worldwide. Disease-modifying antirheumatic drugs (DMARDs) are the cornerstones for the treatment of immune-mediated inflammatory diseases (IMIDs), but risk of malignancy is a major concern for patients receiving DMARDs. In addition, many IMIDs already carry higher background risks of neoplasms. Recently, the black box warning of malignancies has been added for Janus kinase inhibitors. Also, the use of biologic DMARDs in patients with established malignancies is usually discouraged owing to exclusion of such patients in pivotal studies and, hence, lack of evidence. In contrast, some conventional synthetic DMARDs (csDMARDs) have been reported to show antineoplastic properties and can be beneficial for patients with cancer. Among the csDMARDs, chloroquine and hydroxychloroquine have been the most extensively studied, and methotrexate is an established chemotherapeutic agent. Even cyclosporine A, a well-known drug associated with cancer risk, can potentiate the effect of some chemotherapeutic agents. We
review the possible mechanisms behind and clinical evidence of the antineoplastic activities of csDMARDs, including chloroquine and hydroxychloroquine, cyclosporine, leflunomide, mycophenolate mofetil, mycophenolic acid, methotrexate, sulfasalazine, and thiopurines. This knowledge may guide physicians in the choice of csDMARDs for patients with concurrent IMIDs and malignancies.