TNF-alpha inhibitors associated with uveal melanoma

Source: Oncology Nurse Advisor, November 2014

According to new findings reported in the journal Mayo Clinic Proceedings, researchers warn that there may be a correlation between tumor necrosis factor (TNF)-alpha inhibitors and the development of uveal melanoma.

The researchers report three cases of uveal melanoma that occurred after patients were treated with TNF-alpha inhibitors. Two of the patients were treated at Mayo Clinic in Rochester, Minnesota, and the other was treated at Yale-New Haven Hospital in New Haven, Connecticut. All three, two women and one man, were treated for inflammatory disease with TNF-alpha inhibitors.

This class of drugs include adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab, and they are used to treat inflammatory bowel disease, psoriasis, and rheumatoid arthritis. In the cases reported, the two women were treated for inflammatory bowel disease and developed rapidly growing melanocytic tumors within 1 year of TNF-alpha inhibitor initiation.

The male patient was treated for rheumatoid arthritis and developed a uveal melanoma within 16 months of TNF-alpha inhibitor therapy.

The researchers suggest that there is an association between TNF-alpha inhibitors and cutaneous melanoma and recommend that patients planning to initiate TNF-alpha inhibitor therapy have an eye exam before beginning therapy. If patients have preexisting nevi, they should be monitored with eye examinations at regular intervals during therapy.

One of the family of drugs prescribed for rheumatoid arthritis and other inflammatory conditions is called TNF inhibitors. In one of the balancing acts of medicine, the anti-inflammatory action of the drug also increases the risk for other conditions, in this case, a rare form of eye cancer, uveal melanoma.