The significance of pre-screening of subclinical malignancies before the treatment of biologic agents or jak inhibitors to connective tissue disease patients

Background Malignancies under the treatment of biologic agents (Bio) or JAK inhibitors (JAKi) are attracting public attention [1] [2] . It is important to administer Bio or JAKi safely to the patients, it seems to be absolutely necessary of the screening of cancer. Intensive pre-screening examinations for malignancies before the treatment of Bio or JAKi has been performed in our department since 2016. Objectives To elucidate the utility of the intensive pre-screening examination and the prevalence of malignancies prior to the therapy of Bio or JAKi to the patients of connective tissue diseases (CTD). Methods Three hundred thirty-six CTD patients (RA:254, SLE:27, SpA:25, Vasculitis:13, Overlap syndrome:6, others:11) before the administration of Bio or JAKi were enrolled from April 2016 to September 2021. Upper gastric intestinal endoscope, fecal occult blood test (twice), thyroid and abdominal ultrasound, chest and abdominal non-contrast enhanced CT, serum prostate-specific antigen (only for male) and screening for the cancer of the cervix and mammography (only for female) were performed to all patients above as an intensive pre-screening examination. Herein, we retrospectively analyzed the prevalence of both benign and malignant tumors including species before the therapy of Bio or JAKi, and the patient-treatment outcomes with cancers. Results The patient characteristics were as follows: Median age: 68 yr.(n=336). (RA:69 yr., SLE:48yr., SpA:63yr., Vasculitis:73yr., Overlap syndrome:70yr., others:57yr.). The prevalence of benign tumors and malignant tumors were 24.7% (n=83, median age:68yr.) and 5.1% (n=17, median age:74yr.), respectively. The details of the malignancies were prostate cancer (n=6, 35.3%), uterus or ovarian cancer (n=3, 17.6%), gastric cancer (n=3, 17.6%), colon cancer (n=2, 11.8%), breast cancer (n=1,5.9%), lung cancer (n=1, 5.9%) and thyroid cancer (n=1, 5.9%). Most of the age complicated with cancers was 80yr (median) except for those of uterus or ovarian cancer:50yr(median). Eleven patients (64.7%) among cancer bearing patients (n=17) successfully administered Bio or JAKi after radical operation such as endoscopic or surgical resection and all of the 11 patients achieved clinical remission. Conclusion Subclinical malignancies were detected by means of intensive pre-screening examinations. The most common cancer was prostate cancer, subsequently uterus or ovarian cancer and gastric cancer. It is important to perform pre-screening examinations before an aggressive therapy such as Bio or JAKi to CTD patients. References [1]N Engl J Med 2022;27;386(4):316-326 [2]Rheumatol Ther 2017;4:333-347 Acknowledgements: NIL. Disclosure of Interests Kenta Misaki Speakers bureau: Astellas, Bayer, Boehringer Ingelheim, Eli Lilly, Chugai, Sanofi, Kyowa-Kirin, Abbvie, Kowa, Pfizer, Ono Pharmaceutical, UCB, Mitsubishi-Tanabe, Gilead Sciences, Nippon Shinyaku, Novartis, Eisai, Janssen, Taisho, Teijin, VIATRIS and Asahi-kasei; and has received research grants from Ono Pharmaceutical, Grant/research support from: ONO PHARMACEUTICAL CO., LTD, Yamamoto Mako: None declared, Takuya Okada: None declared, Yusuke Tarutani: None declared, Moemi Yabe: None declared, Kenshi Inoue: None declared, Naofumi Dobashi: None declared, Yasuhiko Imaizumi: None declared.