Rheumatoid Arthritis and BC: Link to biologic treatments?
Hello, I have breast cancer as well as 2 autoimmune diseases, Rheumatoid Arthritis and Behcets disease. I have had a long history of breast issues (lumps, cysts, density, etc.) but was diagnosed with my autoimmune diseases only 3 years ago. I started immediately on the "hard" stuff, biologic treatments (Enbrel/Remicade/Humira/Cimzia). I now feel with certainty that there is a link to the biologic and my developing breast cancer. My tumors (4) grew within 11 months of my last mammogram. Anyone else develop BC while on a biologic?
I am also worried about the future. Obviously I had to go off the biologic, and with how I feel am glad to have them out of my system. Unfortunately, these were the only treatments that helped. With my fear of the link, I don't think I would feel safe going back on a biologic, but know nothing else truly helped. Anyone with a similiar experience and any other treatments you found to work other than biologics? Thanks.
Comments
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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! -
Hi, I have breast cancer, autoimmune thyroid disease, autoimmune alopecia and now psoriatic arthritis (with very mild psoriasis). I was started on sulfasalazine last April, after a normal mammogram and ultrasound in March, and in July I was found to have a 12mm tumour. I know this was probably growing before the sulfa but I can't help but wonder if fiddling with my immune system made it grow faster. Now they want to put me on plaquenil instead and I am very dubious. I think I'm doing OK on just anti-inflammatories. It's so difficult, isn't it!
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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.
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Hi Heather:
Thank you for posting this question and opening this forum as many women and men may be wondering about these biologic medicines as well. I also have RA (and hypothyroidism) and took a biologic regime for several months, then steriods daily for over a year, and Methotrate before that for RA. About one year after that treatment plan, I was diagnosed with BC - and I also wonder if the biologic medicine had anything to do with my diagnosis.
What I have found to feel better with RA and inflammation. I take Plaquinil twice daily and stay away from night shade vegitables, limit dairy and red meat, and take probiotics. It took about three weeks for me to feel better, but my blood tests are also showing no inflamation. Hope this helps.
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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.
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I was dx with Rheumatoid Arthritis in '96, and took all sorts of toxic meds in the beginning. I injected Methotexate, once a week, for 7 years, couldn't take the tablets for extreme nausea. Anti-infammatories gave me stomach ulcers and the Plaquenil made me feel weird.
I begged my specialist to let me try some alternative treatments, I hate taking meds of any kind. Fortunately, he is pretty switched on, and came up with some interesting alternatives.
I have managed for the past 7 or 8 years just on a small daily dose of Prednisone, probiotics and green lipped mussel extract. I use a blend of aromatherapy oils in carrier oils that are potent analgesics.
All of this has helped the inflammation enormously. I have a massage fortnightly and do a form of yoga called the 5 Tibetan Rites every day.
I have had a few surgeries to straighten my hands and fix my wrist. I had the sinovial pockets removed from my hand, and had my tendons split to bring the fingers back into line. It worked very well.
I was very lucky to only be dx with DCIS, albeit high grade, but I wonder what may have been the catalyst that kicked it off.
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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.
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I have had Rheumatoid Arthritis for 32 years and have been on every medication known to man. 10 years ago I was on injectable Enbrel and developed Necrotizing Fasciitis. Ten years later, I've developed IDC. Two tumors in the left breast right next to each other. One being triple negative and the other HER2+. I have no doubts I got Necrotizing Fasciitis because of Enbrel and I often wonder if I've developed breast cancer for the same reason. Unfortunately as RA patients we don't have too many options if we want to feel decent in our everyday lives. We have such difficult choices to make about which meds we should take and at what risk. My current meds are Celebrex, Azulfidine and Plaquenil. My Rheumatologist wants me to keep taking them during chemo but my Onc thought I should stop. I've decided to stop them for as long as I can during chemo.
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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
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I was diagnosed with RA 4 years ago. I only took advil for the pain. I didn't like the side effects for the medicine they wanted to prescribe to me. I probably would've blamed the biologics too if I had taken them.
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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! -
I developed NF 11 days after my one and only dose of chemo back in Aug 2011. My drs all say it was from the chemo. No explanations have ever been given. I now live with daily pain that I'm trying to understand. How are you coping with everything? -
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. -
so I have had pain, burning, at times pins and needles sometimes throbbing, radiating down left arm, for about 3 months. I asked my oncologist about it today, she said an X-ray of my c spine might be a good idea. I went after treatment to diagnostic imaging at 1230. The oncologist phoned at 3:30 to tell me I probably have arthritis. But. I had a bone scan in May and a CTscan of my thorax and head roughly the same time. I did not have arthritis then. Does arthritis suddenly appear? I though it was a chronic slow insidious onset kind of a disorder. I guess that is wrong. -
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! -
Thanks for the suggestion BLinthedesert. I thought three months was fast for onset of arthritis. When I get any new sensation, pain, lump, what ever, unless it is causing me excruciating pain, I try to mull it over. Seek understanding. If I can't figure it out, physiologically, I have friends who, like me have health sciences education who I can run things by. It's the problem solving way of getting to a diagnosis. Sometimes tedious, but since I'm not getting out of this life alive, I figure I've got nothing but time.
I am going to try exercise, beyond yoga 2x per week.
But I was wondering if there might be an association between breast cancer/docetaxol/herceptin, letrozole. And now just herceptin and rapid onset of some kind of arthritis, and if it resolves if you ever dare stop herceptin? Any ideas? -
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
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Hi Kay, I have heard, as Usha suggests, that joint pain is a side effect of some AIs. There has also been a lot of anadotal evidence that people with autoimmune disease have found relief from symptoms while on chemotherapy (even though they quit their DMARDs/biologics).
Good luck, and please let us know what you find out. -
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. -
It really does sound odd, Kay. Although, I have heard that arthritis can look distinctive. That said, I am a runner and have also had the experience of being told 'it is probably arthritis' (of the osteo variety) when they don't know what it is (ended up being of the muscular variety of runner stuff:-) ). That is why I thought you might be better served finding a different type of practioner who might try massage or soft tissue manipulation (and really, try the pillow change). I have a wonderful ART (active release technique, www.activerelease.com) that I see - he helps me with a lot of things, the running stuff, "frozen shoulder", etc. Many ART practioners are chiropractors as well.
I hope you get some relief, and I hope it is not cancer related. I understand , and respect your decsion on the AI. -
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. -
Hi, Just read your post . I had BC last year with mastectomy and chemo . I also have RA,OA, and Fibromalgia. I take plaquenil, Endep, jurnesta, lyrica and now methotrexate along with many more . I do wonder a lot if they caused the aggressive fast growing tumor I had. Who knows . Wish I did. Having breast reconstruction in a month. I don,t sleep well anymore . It's always on my mind, pushed to the back of my mind most of the time .but nevertheless always there . Take care Lynne -
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 arthritisPublished
on April 2, 2012 at 2:31 AM·1 CommentNew 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 -
edoyrest, I'm so sorry I didn't see your question until now. I am doing very well after NF. I feel so fortunate to be alive after everything. I'm sorry you're in so much pain. I hope you're still on these boards. Please feel free to PM me if you'd like to compare stories or you need someone to talk to. NF was the most challenging thing I've been through in my lifetime so far, and I hope to never go through it again. I had a colostomy, a colostomy reversal, three debridement surgeries and lost about 1/4 of a butt cheek. Due to the surgeries, I've developed an incisional hernia and a fistula from wounds that wouldn't heal. I spent almost a month in intensive care and a year in a hospital bed at home, but I refused to let it get me down. On rare occasions I get a little tired of fighting it all, but I'm thankful for every day and I appreciate life so much more after NF. Now I get to see a whole new disease and I feel so badly about what some of the ladies here have to go through. I've gone through chemo and surgery with no new infection, and will be starting radiation shortly if all goes well.
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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!
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Scooter, thanks for that info. Very interesting.
MusicLady, Welcome to BCO. Sending best wishes for your surgery.
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Thanks you, SDB! This is an amazing site! Now resting comfortably after my surgery, waiting for results of path report.
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MusicLady, sending good thoughts your way for clean margins and quick healing!
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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.
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islandmom, I've been on Plaquenil for a very long time and don't have any side effects. My RA doc has my eyes checked every six months for pigment changes which can be a SE.
I'm glad the diet change has given you so much benefit.
I've gained 40 pounds with BC treatment and so far my weight hasn't budged. Very frustrating.
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