Rheumatoid Arthritis and BC: Link to biologic treatments?

I have breast cancer, rheumatoid arthritis, and thyroid disease. I took one round of Humira, and 8 days later, I had a severe allergic reaction. I had fever, an uncontrollable rash, and it lasted for 11 days. I feel in my heart that the Humira caused my breast cancer, too, although my onc says probably not.



I take an old drug for RA, sulfasalazine, 5 mg of prednisone, and azathioprine, and plaquenil. It controls the RA pretty well. I take Herceptin for my Stage IV cancer, as well as Xgeva and Faslodex shots. A lot of medicine, but I'm doing pretty well.



I think some rheumatologists think that methotrexate is the only way to go, but that's not the case. Good luck!

I have had psoriasis for years and was just diagnosed with psoriatic arthritis, I am scared to death to go on a biologic but I have issues with Nasaids. I was told the one that I would go on is not linked to breast cancer but may cause other cancers such as Lymphoma. I just don't know what to do.

I have RA and bc. My rheumatologist said that she would not give me humira or enbrel because there is a risk of cancer and with my history she would rather not prescribe it. I take arava and prednisone and do very well but the bc is back and has metastized to the bone. So what's the answer...I think it is what it is.

I was dx with RA in 1989 and been on about everything till finally Actemera worked for me, a biologic.  I developed bc a year later.  I have heard mixed regarding the cancer from the RA doc saying she had only seen blood cancers, not hard cancers from biologics to my onc saying she thinks my bc is from the biologic, to an infections disease doc telling me that no, the biologic didn't cause the bc.  So I really don't know and at this point, it really doesn't matter to me how it got there or what started it.  I don't know and sounds like they don't either.  I found that the chemo and radiation helped with my RA symptoms. I am now on plaquinil as she says this doesn't interfere with my compromised immune system (I'm on oral chemo now) and wonderfully, this is working for my joints pretty well.  I just can't beat myself up on coulda, shoulda.  However, if I knew what I know now, to be really safe, I would not do the biologic as it seems there is not enough consensus on it and hard cancers.

I have psoriatic arthritis(autoimmune) I was diagnosed with BC and was not on a biologic medicine. Maybe I just have an issue with fast growing cells

I was just diagnosed with psoaritic arthritis (mild psoriasis - so mild that I never even got treated for it, a little dab of steroid cream and it was gone). I am a fairly competitive runner, so this has been pretty depressing. I just started methotrexate - and luckily am tolerating the side effects well. I have inflammatory bowel disease (also autoimmune, likely not coincidentally) so I was not supposed to take NSAIDs, I tried Celebrex and it caused a huge flare in my IBD (horrible) -- sort of a bummer because the pain can sometimes be pretty bad (especially when it wakes me up in the middle of the night). Anyway -- it is overwhelming, but I am willing to try biologics if it means I can keep running. There is a lot of evidence that there is a link between inflammation and cancer (especially breast and colon cancers) -- so keeping inflammation at bay is important for everyone.

So, basically, I believe the link is less with the biologics, and more with the high inflammatory state that is present with these autoimmune diseases. But no one really knows. If you can avoid drugs, DMARDs or biologics, then by all means, it is better to do so, but you do risk joint degeneration (which is irreversible once it happens). It is a hard call to make, in my opinion.

There are some diets that are supposed to be anti-inflammatory - and I have some friends that swear by them, if you want, I can post some links.

Best of luck ladies!

Ironically, I've had RA 30 yrs before showing with ILC. Typically it was controlled with NSAIDs although not the best. For decades it was argued if I had it or not since the only test positive is CRP. This past year dx was Seronegative RA. Now in second flare of the year. Have been switched from Placquenil to Azulfidine. Rheum earlier in the year said no you can't take most of the biologics because you've had the BC. Rheum now says you didn't have chemo and even if youi do need methotrexate at some point, its a far less intense dosage than chemo. Told her not without Onc giving the okay, we both agreed. Not there yet and hoping don't need to. This does seem to flare more readly with no estrogen circulating in the body between the Lupron and AI.

Kay, sorry to hear about the pain. CT scans might not pick up joint problems well, so it is possible that you have had some joint deteriation/inflammation for a while. There are different causes/types of arthritis, osteoarthritis can be a slow process, inflammatory types can actually come on pretty suddenly (mine did, it was quite a shock to me). With the throbbing and 'pins and needles' feeling, I would wonder if you have a pinched nerve? I might go to an orthopedist or a really good chiropractor (I say a really good one because if you do have arthritis manipulation won't really help so what you want the chiro to do is evaluate whether or not some massage or muscle manipulation could help relax the muscles near the area -- also, you might need a better pillow).

That's sound like a long time for symptoms like that, I hope you figure it out soon!

Hi, Kay,

I was on Femara ( letrozole) for 20months. I got terrible arthritis in hands, fingers knuckles, and extreme pain in spine. I was disconnected and set on Aromasin (exemestane). It’s a little more tolerable, but bone pains are known as one of SE’s from all AI’s. Most ladies on Hormonal Therapy are having such difficulties. Look upon BCO Treatments & Side Effects Therapy, Staying on Track.

Best wishes,

Usha

I went through the aching joints. That and a few other s/e particularly depression made me decide not to take the letrozole (Femara). I told my DH and my oncologist that if the treatment was supposed to be palliative and now I needed other medicines with s/e to counter act the S/e from the AI that I would be stopping taking it forthwith. It is an informed decision and I recognize that I am taking a calculated risk.

Strange thing is. I never had a radiologist say I had arthritis in any joints before and believe me I think I should go out as a skeleton for Hallowe'en, I am sure I glow in dark from all of the scans, with radionuclide or without since my diagnosis with cancer more than 3 years ago.

thanks BLinthedesert. I am always on the look out to increase my creature comforts. A new pillow and a massage (and some NSAIDs) will give me a whole new outlook on tomorrow.

 Ladies,  University of North Carolina, just completed study ( with mice)

 on the correlation between BC and RA patients. I do believe the DMARDS put us (BC survivors) at higher risk however, if you examine the current studies on BC and RA, you will find that developing the autoimmune disease puts you at greater risk for metastatic  BC in the lungs and bones.   I am a BC survivor of 7 years,  I was Stage II, ER positive, I had a lumpectomy, chemo, and radiation. I took tamoxifin for 1 year and Femara for 5.  I believe the Femara caused the development of my RA.

 google  the article: see below:

Study confirms
link between breast cancer and autoimmune arthritis

Published
on April 2, 2012 at 2:31 AM·1 Comment

New research shows it may be no accident
when doctors observe how patients suffering from both breast cancer
and arthritis
seem to have more aggressive cancer.
However, the new-found interaction between the two diseases may also suggest a
possible treatment.

A potential relationship between
metastatic breast cancer and autoimmune arthritis, as suggested by past
epidemiological studies, has led researchers from the University of North
Carolina at Charlotte to perform a series of mouse model experiments that appear
to confirm the connection.

"Epidemiological studies have
implied that breast cancer survival is significantly lower in patients who also
had autoimmune arthritis," noted Pinku Mukherjee, Irwin Belk Distinguished
Scholar of Cancer Research at UNC Charlotte, whose lab conducted the
experiments. "As there is no obvious reason this should be so, we were
interested in exploring possible cancer mechanisms that might explain
why."

The experiments point to an intimate
relationship between mast cells - immune system cells that are located in
various tissues and that can cause inflammation - and metastatic tumors.

In previously published studies, UNC
Charlotte cancer
researcher Lopamudra Das Roy and her mentor Mukherjee established that breast
cancer associated metastases were significantly higher in arthritic mice, with
a threefold increase in lung metastases and a twofold increase in bone
metastases.

In their most recent work, the researchers
found that mast cells and their associated inflammation are present in larger
numbers in the bones and lungs of arthritic mice than they are in non-arthritic
mice. Their findings point to a relationship between the cKit receptor found on
mast cells and the transmembrane stem cell
factor (SCF) ligand found on metastatic breast cancer cells. The interaction
between SCF and cKit appears to play a critical role in facilitating metastasis.

"We confirmed the relationship we
suspected between autoimmune
disease and metastastic breast cancer
cells," Mukherjee said. "This is an exciting result for us because it
confirms an interesting interdependence between cancer metastasis and a
specific component of the immune system."

The study results will be presented by
Lopamudra Das Roy, Research Assistant Professor at UNC Charlotte, and Mukherjee
at the 2012 American Association for Cancer Research Annual Meeting in Chicago
at a press conference on April 1.

The researchers worked with two strains
of mice. The first group had spontaneous arthritis (SKG mice) and the second
group of mice had spontaneous breast cancer
(MMTV-PyV MT mice). Each of the mouse strains were artificially induced to
develop the other disease and then tested for differences.

Among the findings of the analysis was
that the population of mast cells within bone and lung microenvironment was
significantly higher in those mice with arthritis
and breast cancer
vs. those without arthritis and breast cancer.
The differentiation of mast cells from bone marrow
derived stem cells
was also significantly higher in the arthritic versus the non-arthritic
tumor-bearing mice.

Mast cells are the only "terminally
differentiated" (mature) cells in the body that develop, like blood cells,
from stem cells in the bone marrow and that also have a c-Kit receptor.
Suspecting a relationship between the c-Kit receptor on the mast cells and the
SCF ligand expressed by the metastatic cancer cells, the researchers tested the
effect of blocking receptor by treating the mice with an anti-c-Kit receptor antibody
and celecoxib,
an anti-inflammatory medication.

"When the mice were treated with a
therapy to target the c-Kit mast cell receptor in combination with celecoxib --
a drug used to treat autoimmune arthritis -- the incidence of breast cancer metastasis
to the bone and lung was greatly reduced," Das Roy noted.

The researchers conclude that in an
arthritic condition, SCF expression in metastatic breast cancer cells induces
the differentiation of mast cells from bone marrow through SCF/CKit signaling.
Mast cells, in turn, facilitate the efficient metastasis of the breast cancer
cells in bone and lung tissue. Autoimmune arthritis disease increases the
intensity of metastatic breast cancer
because bone marrow stem cells in autoimmune arthritis victims have greater
potential to develop into mast cells.

In future studies, the researchers plan
to examine the presence of mast cells in human tumor samples.

Source: University of
North Carolina at Charlotte

Dear heather214,

I was dx'd with Psoriatic Arthritis in 2010 and was on the biologic Enbrel injections till my breast biopsy last month which confirmed my BC.  My rheumy says I can never go back on Enbrel again once I've had cancer. He has another biologic in mind for me once I'm out of BC treatment....don't know the name of it.  In the meantime, I'm wondering how I'll do over time with being off-treatment for my PsA.  Enbrel worked like magic for me, so I feel somewhat uncertain about how I'll do without it.  After one month, it's not been too bad yet. Hope it stays that way.

Tomorrow is my lumpectomy.  Then radiation later on.  I wish you well!

Thanks you, SDB!  This is an amazing site!  Now resting comfortably after my surgery, waiting for results of path report.

I have recently got diagnosed with RA and Sjodren's Syndrome.  The rheumatologist said no biologicals for me because of my cancer history.  She put me on Plaquenil.  I have been on it for only couple weeks and so far no side effects.  

The day she gave me the formal diagnosis, about three weeks ago,  I changed my diet and I have not looked back.  I have not had any meat, gluten, sugar.  The morning stiffness is gone.  I have some occasional shooting pain in my joints but is very infrequent.   My doctor also told me to continue with my exercise routine which includes weight lifting.   

I never been a person to do diets of any kind, but I have to say I have become a believer.  Last night was the first time I craved ice cream, I had a peach instead.   You think by avoiding sugar, flour.... I would loose weight,  well I have not lost a single ounce, but my mind seems clear.