Recommendations of Multiple Sclerosis and Neuroimmunology Section of Polish Neurological Society and Immuno-oncology Section of Polish Society of Oncology on oncological risk in patients with multiple sclerosis undergoing immunomodulatory therapy
Abstract
Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system (CNS) that is usually diagnosed between the ages of 20 and 40. Changes in the immune system also observed in cancer may suggest a higher prevalence of cancer in the MS patient population. In recent years, many highly effective immunosuppressive drugs have been introduced into disease-modifying therapy (DMT) which may be associated with a higher risk of cancer development in patients with MS. This paper presents current data on the oncological risk of individual drugs. In addition, it provides recommendations on the management for qualifying for DMT and monitoring the safety of the therapy from anoncological perspective.
Keywords: multiple sclerosisoncological riskcancerimmunomodulatory therapy
References
- Compston A, Coles A. Multiple sclerosis. Lancet. 2008; 372(9648): 1502–1517.
- Tao C, Simpson S, van der Mei I, et al. MSBase Study Group. Higher latitude is significantly associated with an earlier age of disease onset in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2016; 87(12): 1343–1349.
- Piasecka-Stryczyńska K, Kaczyński Ł, Rolka M, et al. Systematic review and network meta-analysis (NMA) for cladribine tablets in achieving sustained disability improvement (SDI) in multiple sclerosis. Neurol Neurochir Pol. 2022; 56(6): 480–489.
- Polish National Cancer Registry 2023. https://onkologia.org.pl/pl (2024-08-09).
- Lalmohamed A, Bazelier MT, Van Staa TP, et al. Causes of death in patients with multiple sclerosis and matched referent subjects: a population-based cohort study. Eur J Neurol. 2012; 19(7): 1007–1014.
- Bahmanyar S, Montgomery SM, Hillert J, et al. Cancer risk among patients with multiple sclerosis and their parents. Neurology. 2009; 72(13): 1170–1177.
- Marrie RA, Reider N, Cohen J, et al. A systematic review of the incidence and prevalence of cancer in multiple sclerosis. Mult Scler. 2015; 21(3): 294–304.
- Maric G, Pekmezovic T, Mesaros S, et al. Occurrence of malignant diseases in patients with multiple sclerosis: population-based MS Registry data. Neurol Sci. 2022; 43(12): 6839–6846.
- Moisset X, Perié M, Pereira B, et al. Decreased prevalence of cancer in patients with multiple sclerosis: A case-control study. PLoS One. 2017; 12(11): e0188120.
- Ghajarzadeh M, Mohammadi A, Sahraian MA. Risk of cancer in multiple sclerosis (MS): A systematic review and meta-analysis. Autoimmun Rev. 2020; 19(10): 102650.
- Roshanisefat H, Bahmanyar S, Hillert J, et al. All-cause mortality following a cancer diagnosis amongst multiple sclerosis patients: a Swedish population-based cohort study. Eur J Neurol. 2015; 22(7): 1074–1080.
- Grytten N, Myhr KM, Celius EG, et al. Incidence of cancer in multiple sclerosis before and after the treatment era- a registry- based cohort study. Mult Scler Relat Disord. 2021; 55: 103209.
- Nørgaard M, Veres K, Didden EM, et al. Multiple sclerosis and cancer incidence: A Danish nationwide cohort study. Mult Scler Relat Disord. 2019; 28: 81–85.
- Nielsen NM, Rostgaard K, Rasmussen S, et al. Cancer risk among patients with multiple sclerosis: a population-based register study. Int J Cancer. 2006; 118(4): 979–984.
- Feldman D, Krishnan AV, Swami S, et al. The role of vitamin D in reducing cancer risk and progression. Nat Rev Cancer. 2014; 14(5): 342–357.
- D'Amico E, Chisari CG, Arena S, et al. Cancer Risk and Multiple Sclerosis: Evidence From a Large Italian Cohort. Front Neurol. 2019; 10: 337.
- Giovannoni G. Disease-modifying treatments for early and advanced multiple sclerosis: a new treatment paradigm. Curr Opin Neurol. 2018; 31(3): 233–243.
- Klotz L, Havla J, Schwab N, et al. Risks and risk management in modern multiple sclerosis immunotherapeutic treatment. Ther Adv Neurol Disord. 2019; 12: 1756286419836571.
- Avonex. Summary of product characteristic. https://www ema europa eu/en/documents/product-information/avonex-epar-product-information_pl pdf (2024-05-22).
- Betaferon. Summary of product characteristic. https://www ema europa eu/en/documents/product-information/betaferon-epar-product-information_pl pdf (2024-05-22).
- Plegridy. Summary of product characteristic. https://www.ema.europa.eu/en/documents/product-information/plegridy-epar-product-information_pl.pdf (May 22, 2024).
- Rebif. Summary of product characteristic. https://www.ema.europa.eu/en/documents/product-information/rebif-epar-product-information_pl.pdf (May 22, 2024).
- Paty DW, Li DK. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. The IFNB Multiple Sclerosis Study Group. Neurology. 1993; 43(4): 655–661.
- Jacobs LD, Cookfair DL, Rudick RA, et al. Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG). Ann Neurol. 1996; 39(3): 285–94.
- Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. PRISMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group. Lancet. 1998; 352(9139): 1498–504.
- Arnold DL, Calabresi PA, Kieseier BC, et al. Peginterferon beta-1a in multiple sclerosis: 2-year results from ADVANCE. Mult Scler. 2015; 21(8): 1025–1035.
- Sandberg-Wollheim M, Kornmann G, Bischof D, et al. The risk of malignancy is not increased in patients with multiple sclerosis treated with subcutaneous interferon beta-la: analysis of data from clinical trial and post-marketing surveillance settings. Mult Scler. 2011; 17(4): 431–440.
- Bloomgren G, Sperling B, Cushing K, et al. Assessment of malignancy risk in patients with multiple sclerosis treated with intramuscular interferon beta-1a: retrospective evaluation using a health insurance claims database and postmarketing surveillance data. Ther Clin Risk Manag. 2012; 8: 313–321.
- Lebrun C, Vermersch P, Brassat D, et al. Cancer and multiple sclerosis in the era of disease-modifying treatments. J Neurol. 2011; 258(7): 1304–1311.
- Kingwell E, Evans C, Zhu F, et al. Assessment of cancer risk with β-interferon treatment for multiple sclerosis. J Neurol Neurosurg Psychiatry. 2014; 85(10): 1096–1102.
- Copaxone. Summary of product characteristic. https://rejestrymedyczne.ezdrowie.gov.pl/api/rpl/medicinal-products/33337/characteristic (May 22, 2024).
- Johnson KP, Brooks BR, Cohen JA, et al. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind placebo-controlled trial. The Copolymer 1 Multiple Sclerosis Study Group. Neurology. 1995; 45(7): 1268–1276.
- Achiron A, Barak Y, Gail M, et al. Cancer incidence in multiple sclerosis and effects of immunomodulatory treatments. Breast Cancer Res Treat. 2005; 89(3): 265–270.
- Walker J, Smylie A, Smylie M. An Association Between Glatiramer Acetate and Malignant Melanoma. J Immunother. 2016; 39(7): 276–278.
- Tecfidera. Summary of product characteristic. https://www.ema.europa.eu/en/documents/product-information/tecfidera-epar-product-information_pl.pdf (May 22, 2024).
- Gold R, Kappos L, Arnold DL, et al. DEFINE Study Investigators. Placebo-controlled phase 3 study of oral BG-12 for relapsing multiple sclerosis. N Engl J Med. 2012; 367(12): 1098–1107.
- Fox R, Miller D, Phillips J, et al. Placebo-Controlled Phase 3 Study of Oral BG-12 or Glatiramer in Multiple Sclerosis. New England Journal of Medicine. 2012; 367(12): 1087–1097.
- Gold R, Arnold DL, Bar-Or A, et al. Long-term safety and efficacy of dimethyl fumarate for up to 13 years in patients with relapsing-remitting multiple sclerosis: Final ENDORSE study results. Mult Scler. 2022; 28(5): 801–816.
- Gómez-Moreno M, Sánchez-Seco VG, Moreno-García S, et al. Cancer diagnosis in a Spanish cohort of multiple sclerosis patients under dimethylfumarate treatment. Mult Scler Relat Disord. 2021; 49: 102747.
- Aubagio. Summary of product characteristic. https://www.ema.europa.eu/en/documents/product-information/aubagio-epar-product-information_pl.pdf (May 22,2024).
- O'Connor P, Wolinsky JS, Confavreux C, et al. TEMSO Trial Group. Randomized trial of oral teriflunomide for relapsing multiple sclerosis. N Engl J Med. 2011; 365(14): 1293–1303.
- Oh J, Vukusic S, Tiel-Wilck K, et al. Efficacy and Safety of Teriflunomide in Multiple Sclerosis across Age Groups: Analysis from Pooled Pivotal and Real-world Studies. J Cent Nerv Syst Dis. 2021; 13: 11795735211028781.
- Miller AE. Oral teriflunomide in the treatment of relapsing forms of multiple sclerosis: clinical evidence and long-term experience. Ther Adv Neurol Disord. 2017; 10(12): 381–396.
- Fingolimod. Summary of product characteristic. https://ec.europa.eu/health/documents/community-register/2016/20161208136419/anx_136419_pl.pdf (May 22,2024).
- Kappos L, Radue EW, O'Connor P, et al. A Placebo-Controlled Trial of Oral Fingolimod in Relapsing Multiple Sclerosis. New England Journal of Medicine. 2010; 362(5): 387–401.
- Kappos L, Cohen J, Collins W, et al. Fingolimod in relapsing multiple sclerosis: An integrated analysis of safety findings. Mult Scler Relat Disord. 2014; 3(4): 494–504.
- Cohen JA, Khatri B, Barkhof F, et al. TRANSFORMS (TRial Assessing injectable interferoN vS. FTY720 Oral in RRMS) Study Group. Long-term (up to 4.5 years) treatment with fingolimod in multiple sclerosis: results from the extension of the randomised TRANSFORMS study. J Neurol Neurosurg Psychiatry. 2016; 87(5): 468–475.
- Fox EJ, Lublin FD, Wolinsky JS, et al. Lymphocyte counts and infection rates: Long-term fingolimod treatment in primary progressive MS. Neurol Neuroimmunol Neuroinflamm. 2019; 6(6).
- Cohen JA, Tenenbaum N, Bhatt A, et al. Extended treatment with fingolimod for relapsing multiple sclerosis: the 14-year LONGTERMS study results. Ther Adv Neurol Disord. 2019; 12: 1756286419878324.
- Killestein J, Leurs CE, Hoogervorst ELJ, et al. Five cases of malignant melanoma during fingolimod treatment in Dutch patients with MS. Neurology. 2017; 89(9): 970–972.
- Ziemssen T, Lang M, Schmidt S, et al. PANGAEA study group. Long-term real-world effectiveness and safety of fingolimod over 5 years in Germany. J Neurol. 2022; 269(6): 3276–3285.
- Alping P, Askling J, Burman J, et al. Cancer Risk for Fingolimod, Natalizumab, and Rituximab in Multiple Sclerosis Patients. Ann Neurol. 2020; 87(5): 688–699.
- Askari M, Mirmosayyeb O, Ghaffary EM, et al. Incidence of cancer in patients with multiple sclerosis (MS) who were treated with fingolimod: A systematic review and meta-analysis. Mult Scler Relat Disord. 2022; 59: 103680.
- Triplett J, Kermode AG, Corbett A, et al. Warts and all: Fingolimod and unusual HPV-associated lesions. Mult Scler. 2019; 25(11): 1547–1550.
- Macaron G, Ontaneda D. Clinical commentary on "Warts and all: Fingolimod and unusual HPV associated lesions". Mult Scler. 2019; 25(11): 1550–1552.
- Ponvory. Summary of product characteristic. https://www.ema.europa.eu/en/documents/product-information/ponvory-epar-product-information_pl.pdf (May 22, 2024).
- Kappos L, Fox RJ, Burcklen M, et al. Ponesimod Compared With Teriflunomide in Patients With Relapsing Multiple Sclerosis in the Active-Comparator Phase 3 OPTIMUM Study: A Randomized Clinical Trial. JAMA Neurol. 2021; 78(5): 558–567.
- Freedman MS, Pozzilli C, Havrdova EK, et al. Ponesimod Phase II Study Group. Long-term Treatment With Ponesimod in Relapsing-Remitting Multiple Sclerosis: Results From Randomized Phase 2b Core and Extension Studies. Neurology. 2022; 99(8): e762–e774.
- Zeposia. Summary of product characteristic. https://www.ema.europa.eu/en/documents/product-information/zeposia-epar-product-information_pl.pdf (May 22, 2024).
- Comi G, Kappos L, Selmaj KW, et al. SUNBEAM Study Investigators. Safety and efficacy of ozanimod versus interferon beta-1a in relapsing multiple sclerosis (SUNBEAM): a multicentre, randomised, minimum 12-month, phase 3 trial. Lancet Neurol. 2019; 18(11): 1009–1020.
- Cohen JA, Comi G, Selmaj KW, et al. RADIANCE Trial Investigators. Safety and efficacy of ozanimod versus interferon beta-1a in relapsing multiple sclerosis (RADIANCE): a multicentre, randomised, 24-month, phase 3 trial. Lancet Neurol. 2019; 18(11): 1021–1033.
- Selmaj KW, Cohen JA, Comi G, et al. Ozanimod in relapsing multiple sclerosis: Pooled safety results from the clinical development program. Mult Scler Relat Disord. 2021; 51: 102844.
- Myzent. Summary of product characteristic. https://www.ema.europa.eu/en/documents/product-information/mayzent-epar-product-information_pl.pdf (May 22, 2024).
- Kappos L, Bar-Or A, Cree BAC, et al. EXPAND Clinical Investigators. Siponimod versus placebo in secondary progressive multiple sclerosis (EXPAND): a double-blind, randomised, phase 3 study. Lancet. 2018; 391(10127): 1263–1273.
- Cree BAc, Arnold DL, Fox RJ, et al. Long-term efficacy and safety of siponimod in patients with secondary progressive multiple sclerosis: Analysis of EXPAND core and extension data up to >5 years. Mult Scler. 2022; 28(10): 1591–1605.
- Tysabri. Summary of product characteristic. https://www.ema.europa.eu/en/documents/product-information/tysabri-epar-product-information_pl.pdf (May 22, 2024).
- Polman CH, O'Connor PW, Havrdova E, et al. AFFIRM Investigators. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med. 2006; 354(9): 899–910.
- Tysabri WHO Pharmaceutical Newsletter. https://apps.who.int/iris/rest/bitstreams/1134781/retrieve (May 22, 2024).
- Moineau-Vallée K, Rinfret J, Luu Hoai MyH, et al. Successful Management of Natalizumab-Associated Primary Central Nervous System Lymphoma through Autologous Stem Cell Transplant. Curr Oncol. 2020; 28(1): 203–208.
- Nixon M, Menger RP, Kalakoti P, et al. Natalizumab-Associated Primary Central Nervous System Lymphoma. World Neurosurg. 2018; 109: 152–159.
- Bergamaschi R, Montomoli C. Melanoma in multiple sclerosis treated with natalizumab: causal association or coincidence? Mult Scler. 2009; 15(12): 1532–1533.
- Vavricka B, Baumberger P, Russmann S, et al. Diagnosis of melanoma under concomitant natalizumab therapy. Multiple Sclerosis Journal. 2010; 17(2): 255–256.
- Sabol RA, Noxon V, Sartor O, et al. Melanoma complicating treatment with natalizumab for multiple sclerosis: A report from the Southern Network on Adverse Reactions (SONAR). Cancer Med. 2017; 6(7): 1541–1551.
- Kelm RC, Hagstrom EL, Mathieu RJ, et al. Melanoma subsequent to natalizumab exposure: A report from the RADAR (Research on Adverse Drug events And Reports) program. J Am Acad Dermatol. 2019; 80(3): 820–821.
- Ocrevus. Summary of product characteristic. https://www.ema.europa.eu/en/documents/product-information/ocrevus-epar-product-information_pl.pdf (May 22, 2024).
- Hauser SL, Bar-Or A, Comi G, et al. OPERA I and OPERA II Clinical Investigators. Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis. N Engl J Med. 2017; 376(3): 221–234.
- Hauser SL, Kappos L, Arnold DL, et al. Five years of ocrelizumab in relapsing multiple sclerosis: OPERA studies open-label extension. Neurology. 2020; 95(13): e1854–e1867.
- Montalban X, Hauser SL, Kappos L, et al. ORATORIO Clinical Investigators. Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis. N Engl J Med. 2017; 376(3): 209–220.
- Wolinsky JS, Arnold DL, Brochet B, et al. Long-term follow-up from the ORATORIO trial of ocrelizumab for primary progressive multiple sclerosis: a post-hoc analysis from the ongoing open-label extension of the randomised, placebo-controlled, phase 3 trial. Lancet Neurol. 2020; 19(12): 998–1009.
- Hauser S, Kappos L, Montalban X, et al. Safety of Ocrelizumab in Patients With Relapsing and Primary Progressive Multiple Sclerosis. Neurology. 2021; 97(16).
- Steve L, et al. Hauser, L Kappos, Safety of Ocrelizumab in iple osis: Updated Analysis in Patients with apsing and Primary Progressive iple osis. Mult Scler Rel Dis. 2023; 80.
- Kesimpta. Summary of product characteristic. https://www.ema.europa.eu/en/documents/product-information/kesimpta-epar-product-information_pl.pdf (May 22, 2024).
- Hauser SL, Bar-Or A, Cohen JA, et al. ASCLEPIOS I and ASCLEPIOS II Trial Groups. Ofatumumab versus Teriflunomide in Multiple Sclerosis. N Engl J Med. 2020; 383(6): 546–557.
- Lemtrada. Summary of product characteristic. https://ec.europa.eu/health/documents/community-register/2013/20130912126598/anx_126598_pl.pdf (May 22, 2024).
- Cohen JA, Coles AJ, Arnold DL, et al. CARE-MS I investigators. Alemtuzumab versus interferon beta 1a as first-line treatment for patients with relapsing-remitting multiple sclerosis: a randomised controlled phase 3 trial. Lancet. 2012; 380(9856): 1819–1828.
- Coles AJ, Twyman CL, Arnold DL, et al. CARE-MS II investigators. Alemtuzumab for patients with relapsing multiple sclerosis after disease-modifying therapy: a randomised controlled phase 3 trial. Lancet. 2012; 380(9856): 1829–1839.
- Havrdova E, Arnold DL, Cohen JA, et al. CARE-MS I and CAMMS03409 Investigators. Alemtuzumab CARE-MS I 5-year follow-up: Durable efficacy in the absence of continuous MS therapy. Neurology. 2017; 89(11): 1107–1116.
- Coles AJ, Coles AJ, Cohen JA, et al. CARE-MS II and CAMMS03409 Investigators. Alemtuzumab CARE-MS II 5-year follow-up: Efficacy and safety findings. Neurology. 2017; 89(11): 1117–1126.
- Bass AD, Arroyo R, Boster AL, et al. CARE-MS I, CARE-MS II, CAMMS03409, and TOPAZ investigators. Alemtuzumab outcomes by age: Post hoc analysis from the randomized CARE-MS studies over 8 years. Mult Scler Relat Disord. 2021; 49: 102717.
- Rauma I, Mustonen T, Seppä JM, et al. Safety of alemtuzumab in a nationwide cohort of Finnish multiple sclerosis patients. J Neurol. 2022; 269(2): 824–835.
- Daniels GH, Vladic A, Brinar V, et al. Alemtuzumab-related thyroid dysfunction in a phase 2 trial of patients with relapsing-remitting multiple sclerosis. J Clin Endocrinol Metab. 2014; 99(1): 80–89.
- Mahzari M, Arnaout A, Freedman MS. Alemtuzumab Induced Thyroid Disease in Multiple Sclerosis: A Review and Approach to Management. Can J Neurol Sci. 2015; 42(5): 284–291.
- Mavenclad. Summary of product characteristic. https://www.ema.europa.eu/en/documents/product-information/mavenclad-epar-product-information_pl.pdf (May 22, 2024).
- Colovic N, Marisavljevic D, Kraguljac-Kurtovic N, et al. CD56-Positive Acute Myeloid Leukemia Following Treatment of Hairy Cell Leukemia with Cladribine - Report of 2 Cases and Review of the Literature. Arch Iran Med. 2019; 22(5): 269–271.
- Giovannoni G, Comi G, Cook S, et al. CLARITY Study Group. A placebo-controlled trial of oral cladribine for relapsing multiple sclerosis. N Engl J Med. 2010; 362(5): 416–426.
- European Medicines Agency. Refusal of the marketing authorization for Movectro (cladribine): outcome of re-examination. http://www.ema.europa.eu/docs/en_GB/document_Available from: 001197/WC500101072.pdf (May 22, 2024).
- Giovannoni G, Soelberg Sorensen P, Cook S, et al. Safety and efficacy of cladribine tablets in patients with relapsing-remitting multiple sclerosis: Results from the randomized extension trial of the CLARITY study. Mult Scler. 2018; 24(12): 1594–1604.
- Cook S, Leist T, Comi G, et al. Safety of cladribine tablets in the treatment of patients with multiple sclerosis: An integrated analysis. Mult Scler Relat Disord. 2019; 29: 157–167.
