French recommendations for assessing and managing the risk of cancer before the initiation of targeted therapies for chronic rheumatic inflammatory diseases

Jérôme Avouac; Olivier Fogel; Maxime Beydon; Grégoire Martin de Frémont; Gary Birsen; Xavier Carcopino; Claire Immediato Daien; Sandra Desouches; Charlotte Domblides; Cécile Gaujoux-Viala; Jacques-Eric Gottenberg; Jean-Guillaume Letarouilly; Gaetane Nocturne; Clément Prati; Jean Hugues Salmon; Jérémie Sellam; Marie-Elise Truchetet; Marie Wislez; Irène Pico-Philippe; Danielle Vacher; Raphaèle Seror; Anna Molto; behalf of the French Society of Rheumatology

doi:10.1016/j.jbspin.2025.105944

French recommendations for assessing and managing the risk of cancer before the initiation of targeted therapies for chronic rheumatic inflammatory diseases

Joint Bone Spine. 2025 Oct;92(5):105944. doi: 10.1016/j.jbspin.2025.105944. Epub 2025 Jul 12.

Authors

Jérôme Avouac¹, Olivier Fogel², Maxime Beydon³, Grégoire Martin de Frémont⁴, Gary Birsen⁵, Xavier Carcopino⁶, Claire Immediato Daien⁷, Sandra Desouches⁸, Charlotte Domblides⁹, Cécile Gaujoux-Viala¹⁰, Jacques-Eric Gottenberg¹¹, Jean-Guillaume Letarouilly¹², Gaetane Nocturne¹³, Clément Prati¹⁴, Jean Hugues Salmon¹⁵, Jérémie Sellam¹⁶, Marie-Elise Truchetet¹⁷, Marie Wislez⁵, Irène Pico-Philippe¹⁸, Danielle Vacher¹⁹, Raphaèle Seror¹³, Anna Molto²; behalf of the French Society of Rheumatology

Affiliations

¹ Service de Rhumatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre - Université Paris Cité, 75014 Paris, France. Electronic address: jerome.avouac@aphp.fr.
² Service de Rhumatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP). Centre - Université Paris Cité, 75014 Paris, France.
³ 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.
⁴ National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre, Université Paris Cité, 75014 Paris, France.
⁵ Pneumology Department, Thoracic Oncology Unit, Cochin Hospital, AP-HP, Paris Cité University, Paris, France.
⁶ Service de gynécologie obstétrique, hôpital Nord, CHU de Marseille, APHM, Aix Marseille university (AMU), Marseille, France.
⁷ Montpellier University, CHU de Montpellier, Inserm U1046, CNRS UMR 9214, Montpellier, France.
⁸ Service de Rhumatologie, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France.
⁹ Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital, France/Laboratoire ImmunoConcEpt CNRS UMR5164, Bordeaux, France/University of Bordeaux, Bordeaux, France.
¹⁰ Desbrest Institute of Epidemiology and Public Health, University of Montpellier, INSERM, Department of Rheumatology, CHU de Nîmes, Montpellier, France.
¹¹ Rheumatology Department, National Reference Center for Autoimmune Diseases, Strasbourg University Hospital, 67000 Strasbourg, France.
¹² Service de rhumatologie, CHU de Lille, université de Lille, Lille, France.
¹³ Department of Immuno-Rheumatology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, IDMIT UMR 1184, INSERM, Université Paris-Saclay, Paris, France.
¹⁴ Rhumatologie, CHU de Besançon, Université Marie et Louis Pasteur, EFS, INSERM UMR 1098 RIGHT, 25000 Besançon, France.
¹⁵ Department of Rheumatology, University of Reims Champagne-Ardenne (URCA), Reims University Hospital, 51100 Reims, France.
¹⁶ Department of Rheumatology, Saint-Antoine Hospital, Centre de Recherche Saint-Antoine, Inserm UMRS 938, Sorbonne Université, AP-HP, Paris, France.
¹⁷ Department of Rheumatology, UMR5164 ImmunoConcept, Bordeaux University, Bordeaux University Hospital, CNRS, Raba Leon, Place Amelie, 33076 Bordeaux cedex, France.
¹⁸ AFPric, 75011 Paris, France.
¹⁹ ANDAR, 75014 Paris, France.

PMID: 40659179
DOI: 10.1016/j.jbspin.2025.105944

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.

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

Publication types

Practice Guideline

MeSH terms

Antirheumatic Agents* / adverse effects
Antirheumatic Agents* / therapeutic use
Chronic Disease
Female
France
Humans
Neoplasms* / diagnosis
Neoplasms* / epidemiology
Neoplasms* / etiology
Neoplasms* / prevention & control
Rheumatic Diseases* / complications
Rheumatic Diseases* / drug therapy
Risk Assessment
Systematic Reviews as Topic

Substances

Antirheumatic Agents