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Azathioprine, skin cancer and melanomas

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Ulcerative Colitis
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Posted 10/15/2016 5:00 PM (GMT 0)
Hi everybody,

I have been on repeated courses of pred now for one year. Everytime I got off them my symptoms come back. My GI and I have discussed the above risks and it was decided that I would stay on a maintenance dose of pred (15-10mg). I managed to reduce to 20mg and I am now flaring again. My GP increased my steroids again to 40mg. My IBD nurse is not pleased and threw a spanner in the works by mentioning surgery. I don't think this was appropriate at all.

There are two reasons for not taking azathioprine. The first is I have neutropenia, but haemotology say I can have GCSF to stimulate the production of white blood cells. The second is the risks for skin cancer having already had a malignant melanoma. I have seen a dermatologist who said that there would be normally be a slight increased risk of reoccurrence but I was lucky that mine was only very thin and had not spread to deeper skin layers or lymph nodes. He said that I could be at an increased risk if taking azathioprine. The IBD nurse informed me that it was other types of skin cancer that were associated with aza and not so much melanomas.

I am beginning to think maybe I should take aza. I do realised that I have been on steroids a long time.

I just wondered if anyone on here has any experience of this or any other thoughts.

I sometimes feel that the medical profession are reluctant to treat difficult cases because of these risks. A friend of mine had to plead for mesalazine because she had other problems.

Look forward to any replies
Posted 10/15/2016 6:01 PM (GMT 0)
mentioning surgery, as an option, in difficult cases - especially steroid dependent cases, is always appropriate. as long as it is not presented as only option or imminent.

if you feel aza is not an option, then do not take Remicade. Try Entyevo.

I did do a 10mg maintenance dose of pred for a year, but I had no symptoms at that level. If you cannot get to a reasonable maintence dose w/o symptoms, then something new needs to be done.
Posted 10/15/2016 6:07 PM (GMT 0)
I have not heard that melanomas are associated with aza, you could do some research to calm your mind. I was on 6mp (similar) for under a year and started having squamous and basal cell cancer (7 surgeries in 9 years and more ahead). I wondered if it was because of 6mp or co-incidental. My gene test says I have higher risk for squamous and years of tennis (with daily sunblock on) are risk factors too. Fair skin+Irish genes+Florida childhood=skin cancer.

6mp did not help my UC symptoms so easy for me to quit.
It's your body, your decision.
Posted 10/15/2016 8:05 PM (GMT 0)
Mad Martha, I don't know your history, so can you give a quick rundown of your UC? I'm assuming you've been on mesalamines for a while with insufficient results?

There is data out there that imuran/6mp do increase the risk of non-melanoma skin cancer. Imuran/6mp may or may not increase the risk of melanoma - I don't think it's known one way or the other, because the relatively lower numbers of melanoma mean they just don't have enough good data.

But I understand your concerns and would be reluctant as well.

Unfortunately, I think the same situation applies with the anti-TNF biologics - there may be an increased melanoma risk, but there isn't enough data to know for sure.

DBwithUC makes a good suggestion with Entyvio. In this case there's not nearly enough data to know for sure, but *in theory* it should have no effect on skin.

Also, now that Stelara is approved for IBD, you could look into that. Since it has been used for skin issues for a while now, dermatologists might have a better idea whether it's appropriate for somebody with a history of stage 0 or 1 melanoma.
Posted 10/15/2016 11:46 PM (GMT 0)
I'd take biologics like humira or remicade in your case. You're at high risk of reoccurrence of melanoma if you take immunomodulators like 6mp or Imuran/azathioprine, as you've previously had melanoma.
Posted 10/16/2016 7:56 AM (GMT 0)
Not sure why my signature doesn't appear. I was diagnosed with proctitis in 2012. Pred put me into a year remission up until 2014 I think. Inflammation spread then to distal sigmoid and pred and salofalk enemas gave me an 18 month remission. October 2015 saw me flare again and have never got it under control. The inflammation had spread slightly so the the sigmoid was inflamed too.
Biologicals also ply another risk due to me having a motor neuropathy.
Surgery seems a long way off with only sigmoiditis.
Posted 10/16/2016 8:11 PM (GMT 0)
OK, I see your signature in this most recent post but not in your first post. Weird.

Anyway, have you tried Uceris (oral budesonide)? It might help you get off of the prednisone.

Also, have you tried any enemas - steroid or mesalamine?

Both of those would be appropriate to try. If those fail, then Entyvio is probably the next to give a try.
Posted 10/17/2016 11:27 AM (GMT 0)
Sounds like you have a few potential things going on that might affect biologics or immunomodulators. I'd check with your gastroenterologist and see if you can get the odds of those medications impacting you.

Certainly, you need an exit plan off of the pred.
Posted 10/17/2016 4:41 PM (GMT 0)
Beave.....its not weird at all. Its a conscious decision made by administration. Signatures ONLY SHOW AUTOMATICALLY when using quick reply. If one uses post reply, post new topic or edit...that would be the advanced format and the include signature needs to be checked in order for it be visible. If one forgets to include it, editing and checking the box will correct that.

q
Posted 10/17/2016 8:38 PM (GMT 0)
^Ah, I never noticed that! Thanks for the explanation.
Posted 10/17/2016 11:06 PM (GMT 0)
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