Summary of CRA recommendations regarding treatment with traditional and biologic disease-modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA) patients with malignancy (Recommendations 10–13).
| Option | Use with Caution (risk unknown/no evidence) | Use with Caution (some evidence of increased risk) | |
|---|---|---|---|
| Active malignancy, receiving cancer chemotherapy/radiation. | * | * | * |
| History of malignancy | |||
| Lymphoma | Sulfasalazine, hydroxychloroquine, rituximab | Abatacept, tocilizumab | Methotrexate, anti-TNF |
| Nonmelanoma skin cancer | Methotrexate, leflunomide, sulfasalazine, hydroxychloroquine | Abatacept, rituximab, tocilizumab | Anti-TNF |
| Solid tumor | Methotrexate, leflunomide, sulfasalazine, hydroxychloroquine | Abatacept, rituximab, tocilizumab | Anti-TNF (melanoma) |
↵* Treatment decisions should be made on a case-by-case basis in conjunction with a cancer specialist and the patient. Anti-TNF: anti-tumor necrosis factor.