SS04 - Biologic Therapy Is Associated with Improved Oncologic Outcomes in Crohn’s Associated Colorectal Cancer

Sunday, June 2, 2024

8:58 AM – 9:06 AM ET, USA

Location: Ballroom I-II

Abstract Podium Presenter(s)

BG

Bhuwan Giri, MD

Colorectal fellow
Cleveland Clinic
Cleveland Clinic Foundation, Ohio
Cleveland, OH, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

Stefan D. Holubar, MD, MS

Director of Research, Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.
David Liska, MD

Associate Professor of Surgery, Chair
Department of Colorectal Surgery, Cleveland Clinic
Cleveland Clinic, Cleveland, Ohio
Cleveland, OH, United States

Disclosure information not submitted.
OL

Olga Lavryk, MD, PhD

Clinical Associate
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.
BC

Benjamin Cohen, MD

Staff
Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.
Michael A. Valente, DO

Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.
Scott Steele, MD MBA

President, Chairman, Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

LD

Leonardo C. Duraes, MD PhD

Staff Surgeon
Department of Colorectal Surgery
Cleveland, Ohio, United States

Disclosure information not submitted.

Purpose/Background: Crohn’s disease patients face an elevated risk of colorectal cancer risk. Biologic therapy is the mainstay of medical treatment, but the impact of treatment with biologics on cancer outcomes remains unclear. We hypothesized that exposure to biologics was associated with improved colorectal cancer outcomes in patients with Crohn’s disease.

Methods/Interventions: Using a single-center colorectal cancer database, we identified patients with Crohn’s who underwent surgery for colorectal adenocarcinoma with curative intent between 1998 and 2020. Patients were stratified into two groups based on biologic exposure (+BE/-BE) prior to cancer diagnosis. Univariate and Kaplan-Meier analyses were performed.

Results/Outcomes: A total of 56 patients were included, with a median age of 53 years at the time of surgery (p=0.869). Males constituted 63% (p=0.192). A total of 19 (33.9%) patients were treated with biologics prior to surgery: 10 (52.6%) received infliximab, 2 (10.5%) received adalimumab, and 7 (36.8%) had received several biologics. Comparing the +BE to the -BE groups, median disease duration (26.5 vs. 20 years, p=0.054) and baseline characteristics including ASA (p=0.202), Crohn’s disease location (p=0.424) and behavior (p=0.572) using the Montreal classification, and TNM staging (p=0.458) were not statistically significant between the two groups. Rectal cancers (78.9% vs. 43.2%, p=0.022) and well- or moderately- differentiated tumors (93% vs. 50%, p=0.005) were more common in the biologic exposure group. Similar proportion of patients with rectal cancer received neoadjuvant chemoradiation (35.7% vs 50%, p=0.462). After surgery for colorectal cancer, a similar percentage of patients received adjuvant chemotherapy (58.3% vs. 66.7%, p=0.632). Exposure to biologics was associated with a higher 5-year disease-free survival rate (80% vs. 45%, p=0.048, Figure), while 5-year overall survival (93% vs. 57%, p=0.185) and 5-year recurrence rates (7% vs. 31%, p=0.180) were numerically but not statistically different.

Conclusion/Discussion: In Crohn’s disease patients with colorectal adenocarcinoma who underwent curative surgery, those previously exposed to biologic therapy were more likely to have well- or moderately- differentiated tumors, which were more likely to be distal to the splenic flexure, resulting in significantly higher 5-year disease-free survival. These findings suggest that treatment of inflammation in patients with Crohn’s disease fundamentally alters carcinogenesis pathways.