French recommendations for assessing and managing the risk of cancer before the initiation of targeted therapies for chronic rheumatic inflammatory diseases - 26/09/25

Doi : 10.1016/j.jbspin.2025.105944

Jérôme Avouac ^a,^⁎ , Olivier Fogel ^a,^{^{1
These authors have equally contributed.}}, Maxime Beydon ^b,^{^{1
These authors have equally contributed.}}, Grégoire Martin de Frémont ^c,^⁎, Gary Birsen ^d, Xavier Carcopino ^e, Claire Immediato Daien ^f, Sandra Desouches ^g, Charlotte Domblides ^h, Cécile Gaujoux-Viala ⁱ, Jacques-Eric Gottenberg ^j, Jean-Guillaume Letarouilly ^k, Gaetane Nocturne ^l, Clément Prati ^m, Jean Hugues Salmon ⁿ, Jérémie Sellam ^o, Marie-Elise Truchetet ^p, Marie Wislez ^d, Irène Pico-Philippe ^q, Danielle Vacher ^r, Raphaèle Seror ^l,^{^{2
These authors have equally contributed.}}, Anna Molto ^a,^{^{2
These authors have equally contributed.}}
on
behalf of the French Society of Rheumatology
^a Service de Rhumatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP–HP). Centre - Université Paris Cité, 75014 Paris, France
^b Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin-Bicêtre, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Clichy, Paris, France
^c National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP–HP Centre, Université Paris Cité, 75014 Paris, France
^d Pneumology Department, Thoracic Oncology Unit, Cochin Hospital, AP–HP, Paris Cité University, Paris, France
^e Service de gynécologie obstétrique, hôpital Nord, CHU de Marseille, APHM, Aix Marseille university (AMU), Marseille, France
^f Montpellier University, CHU de Montpellier, Inserm U1046, CNRS UMR 9214, Montpellier, France
^g Service de Rhumatologie, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris (AP–HP), Sorbonne Université, Paris, France
^h Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, France/Laboratoire ImmunoConcEpt CNRS UMR5164, Bordeaux, France/University of Bordeaux, Bordeaux, France
ⁱ Desbrest Institute of Epidemiology and Public Health, University of Montpellier, INSERM, Department of Rheumatology, CHU de Nîmes, Montpellier, France
^j Rheumatology Department, National Reference Center for Autoimmune Diseases, Strasbourg University Hospital, 67000 Strasbourg, France
^k Service de rhumatologie, CHU de Lille, université de Lille, Lille, France
^l Department of Immuno-Rheumatology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, IDMIT UMR 1184, INSERM, Université Paris-Saclay, Paris, France
^m Rhumatologie, CHU de Besançon, Université Marie et Louis Pasteur, EFS, INSERM UMR 1098 RIGHT, 25000 Besançon, France
ⁿ Department of Rheumatology, University of Reims Champagne-Ardenne (URCA), Reims University Hospital, 51100 Reims, France
^o Department of Rheumatology, Saint-Antoine Hospital, Centre de Recherche Saint-Antoine, Inserm UMRS 938, Sorbonne Université, AP–HP, Paris, France
^p Department of Rheumatology, UMR5164 ImmunoConcept, Bordeaux University, Bordeaux University Hospital, CNRS, Raba Leon, Place Amelie, 33076 Bordeaux cedex, France
^q AFPric, 75011 Paris, France
^r ANDAR, 75014 Paris, France

^⁎Corresponding author. Service de Rhumatologie, Hôpital Cochin, Université Paris Descartes, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France.Service de Rhumatologie, Hôpital Cochin, Université Paris Descartes27 rue du Faubourg Saint-JacquesParis75014France

Highlights

•	8 expert-backed recommendations for cancer risk in patients with chronic rheumatic inflammatory disorders.
•	Tailored screening plans for immunocompromised rheumatic patients.
•	JAKi and abatacept use require caution in high-risk cancer profiles.
•	Emphasis on HPV vaccination and smoking cessation for prevention.
•	Disease control is key to reducing lymphoma risk in RA patients.

Le texte complet de cet article est disponible en PDF.

Abstract

Objective

Chronic inflammatory rheumatic diseases (CIRDs) are associated with a higher risk of cancer due to persistent inflammation, immune dysregulation, and immunomodulatory therapies. The growing use of targeted therapies necessitates systematic cancer risk assessment prior to treatment initiation.

Objective

To develop practical recommendations for cancer risk assessment and management before initiating targeted therapies in patients with CIRDs, while balancing therapeutic benefits with oncologic safety.

Methods

Conducted under the French Society of Rheumatology, this initiative followed standardized procedures. A multidisciplinary task force was established, including rheumatologists, oncologists, pulmonologists, gynecologists, and patient representatives. Two systematic literature reviews (2005–2024) were performed to assess cancer risk in CIRD patients under conventional and targeted DMARDs. Recommendations were formulated based on evidence synthesis and expert consensus, with multiple voting rounds to establish levels of agreement.

Results

The task force proposed three overarching principles and eight evidence-based recommendations. It advocated the application of general population cancer screening programs, adapted to the specific needs of immunocompromised patients with CIRDs. These adaptations may involve earlier and/or more frequent screening. Recommendations also support systematic risk assessment before initiating therapies, reinforced preventive strategies like HPV vaccination and smoking cessation, and at least one dermatologic evaluation during follow-up. Decisions regarding higher-risk therapies, such as JAK inhibitors and abatacept, should involve multidisciplinary discussions.

Conclusion

These recommendations provide a practical, individualized framework for cancer risk assessment in CIRD patients. By integrating adapted screening, prevention, and shared decision-making, they aim to optimize patient safety while preserving disease control.

Le texte complet de cet article est disponible en PDF.

Keywords : Targeted therapies, JAK inhibitors, Chronic rheumatic inflammatory diseases, Cancer, Lymphoma, Risk, Recommendations