#Anti-tumor necrosis factor-α (anti-TNF) agents are used to treat different autoimmune conditions.
Etanercept and Adalimumab are examples of this class of medications used for the treatment of
Psoriasis. The FDA released a review in 2003 of clinical trials
using anti-TNF agents and reported a relative risk for lymphoma ranging from 2.3 to 6.4.
In 2005, a randomized placebo-controlled trial of Etanercept
vs. placebo in patients with
Wegener’s Granulomatosis found a statistically significant increase in solid malignancies in the
experimental arm. Observational studies, several randomized clinical trials and the subsequent
meta-analysis has emerged with conflicting results. A case of three synchronous malignancies (diffuse large B-Cell lymphoma involving
heart, multiple myeloma, and invasive ductal carcinoma of breast) presenting during the use of
anti-TNF agents (Etanercept and Adalimumab) for psoriasis and review current literature focused
on the association of this therapeutic modality and malignancies. One must remain cautious about
the risk of malignancy with anti-TNF compounds, ensuring age-appropriate cancer screening and
considering avoidance in patients with proved or suspected genetic predisposition for cancer.#