MTX and Increased Risk of All Cancers?

Methotrexate (MTX) is a disease-modifying anti-rheumatic drug (DMARD) commonly prescribed to RA patients. A link between the drug and cancer has been suggested, and there are even concerns that the drug itself may be carcinogenic, but research examining this concern has proven inconclusive.

Way too small a sampling, IMO, to be conclusive..

This new study included 459 RA patients (309 women, 150 men) who started treatment with MTX prior to June 1986. During a total of 4,273 person-years of follow up (an average of 9.3 years per patient), 87 cancers were identified.

I think this study was brought up and discussed on the board before.

One thing I noticed was not only the small sample group, but that it was done in Australia and one of the cancers discussed was skin cancer. I believe Australians have a higher rate of skin cancer cuz of their lifestyle (outdoorsy types) and their environment (sun, sun, sun).

Mtx makes me more sensitive to the sun, so I take precautions. I have been on the drug since 1986, and knock on wood, so far no problems.

But whenever one has concerns about their meds, or read something like this, I think its a good idea to discuss w/your doctor.

Joie2008-07-23 08:06:39

The skin cancer doesn't worry me because I'm careful about exposure and I also thought Australia probably has a higher melanoma incidence anyway. It's the other cancers "of all kinds" that freaks me out and that 50% number. True, it's a small sample but this has just made it that much harder for me to ignore all the other cancer, liver, kidney warnings about this awful drug. I've been looking at The Road Back site but it seems to be mostly about antidepressant drugs and not what Pip often discusses here regarding AP therapy. I've sent her a PM to get more info. Are you out there Pip?

Jesse - you might be on an addiction site with a similar name! The AP site is www.roadback.org.

We were told from the start that mtx was "a drug used to treat cancer that can also cause cancer". If they were telling us that, up front, I don't get why they are doing studies saying vets with RA have more lung cancer.....duh.....Cancer isn't in our families, it was not our major worry, but I can see how it could be for many. Good luck with these difficult decisions.
Suzanne2008-07-23 08:19:19I used MTX for 8 years and my sister-in-law has used it for over 15 years. Neither one of us has had any issues with cancer. Now, I have a strong family history of both heart disease and cancer, so I take care of myself, eat right and do all of the recommended tests.

Lung cancer and RA are related because smoking is considered one of the environmental causes of RA.

http://arthritis.about.com/od/smoking/a/arthritisrisk.htm

http://www.eurekalert.org/pub_releases/2004-10/jws-sat093004.php

I guess when the doctors prescribing mtx for our then three year old daughter told us it was a drug used to treat cancer that can also cause cancer, they were just trying to make us feel better. Also, let me add, that the studies I've read done on the MTX cancer link have yet to determine if the increased risk was due to RA or that the patients were on methotrexate.

I imagine her doctors read studies. Different doctor's have different opinions.I imagine every one knew it is a dangerous drug. That's why you have to have the frequent blood tests. [QUOTE=Lynn49]Different doctor's have different opinions.[/QUOTE]

Perhaps based on clinical experience.....oh, that's too sad think about, isn't it? Whatever. If you need it to function, you need it to function, period.
Suzanne2008-07-23 08:50:38I think you have to do your research, ask questions and in the end do what is most comfortable and effective for you. You also have to have confidence in you doctor and respect his or her opinion, based on their experience with a treatment.

When my youngest daughter was diagnosed with thyroid cancer, we had three very different opinions about how we should proceed.

In the end, we weighed the research, asked a ton of questions and went with a total thyroidectomy and an ablation. Some of the other doctor's thought that was overkill, but that was the treatment that we, as a family, felt most comfortable with. It certainly wouldn't be everyone's choice, but we did what we felt best....

Duh, thanks Suzanne. I had Googled "The Road Back." That explains it. I e-mailed them for info too. Oops! Gotta get off that subscription now.

Lynn, is your daughter OK now? How horrible to have to deal with serious illness that involves your children. I know you're one of a few here who do and my thoughts and prayers are with you all. It seems to me the only thing worse than having to make these difficult decisions for myself would be having to make them for my child. Bless your hearts.

It's true that many dangers of MTX are known and that's why we get blood work done regularly, but it just seems that they're learning of more problems as time goes on. On the other hand, MTX has been used for so many years, I would think they'd know everything there is to know about it's side effects by this time.

[ Whatever. If you need it to function, you need it to function, period.
[/QUOTE]

That's what I find so frightening and frustrating about this whole thing. What choice do we have? When discussing it with my husband, who encourages me to go off the drugs, I said, "OK, do I go off the meds and live in pain and risk becoming totally deaf and crippled to boot, or do I risk cancer?" Seriously, which is the lesser of the two evils? We just don't know.

For us RAers, its tough having to make these decisions about which drug treatment to pursue. But keep in mind, the goal is to control inflammation, cuz that is what causes joint damage and will limit function, range of motion. So AP, biologics, fish oils, meditation, pool therapy, whatever you choose -- be proactive, keep yourself in the best condition as possible in the hopes of better choices, better drugs, becoming available in the future.

This has been the problem for ages about using RA drugs. Weighing both sides of the issues and making a determination based on your lifestyle and health. I'll need more than the above study of approximately 400 individuals before I change my medications, especially now that I'm in clinical remission. I had of skin cancer surgery last year, is it because of MTX or because I live 8 months of the year on the beach in Mexico? I think it's highly likely that my suppressed immune system and sun caused it. All I can do is wear protection and use the smallest amount of MXT possible to control my disease.

If you're on these drugs you need to do everything possible to help yourself. Quit smoking, lose weight, eat sensibly, be careful in the sun, take care of yourself as much as possible and have a positive attitude and laugh as much as possible. This in itself will go a long way in keeping you healthy. Lindy

Jesse,

My daughter is doing very well. No recurrence of the cancer now for over five years and she feels good.....

. She will always be, as her endrocrinologist says...A high risk patient. But she eats well, exercises( she runs marathons) and most importantly, lives life to its fullest!

There are often tough choices to make when you're ill. I chose to try and feel as good as I can. The Rituxan has made it possible for me to drop both MTX and prednisone...but if I had a relapse, I wouldn't hesitant to use the MTX again. I haven't had any problems with most of the meds and really, there are risks with everything.

Everyone has to find their own comfort zone with this disease. For me it is being able to be active and independent...I can't stand to feel helpless!

I like reading these encouraging posts with their comments that make a lot of sense. I keep going back and forth on this issue and have now contacted the correct site for information. It can't hurt to educate myself some more. Since I don't have inflammation, per se, I'm not sure if I need to be treating this like true RA, although the RA drugs have helped. While thinking more about my options, in one way it seems easy...... I don't know for a fact that I will get cancer, and the blood work will help tip me off if anything is amiss with my liver, and I don't know if I'll lose the hearing in my other ear if I go off the meds, but I DO know I'll be in pain and the symptoms will get worse without them. So on one hand it seems like my choice (and that for many others here) is clear. But that one variable, AP, has become more interesting to me because it seems more benign. The important thing that I have to be convinced of is that I will not make things worse by stopping the RA drugs to try something that will not be effective in the long run. There's much more research to do.....Lynn, that's wonderful news. I'm so glad your daughter is doing well. You obviously made the right choice for her care. Speaking of cancer risks, heavy cosumption of alcohol increases risk of oral, throat and esophagal cancers.

Jan

As does smoking, but we don't have to smoke in order to prevent pain and physical damage. That isn't to say that it's easy to quit, only that we aren't dependant on it. It's the awful reality of being forced to ingest something you know is dangerous to your health that freaks me out. It's just a lousy trade-off with crummy odds. Small study or not, we do know MTX has many dangers and I've just about reached the point of wanting to chuck it and try something else. Jesse - good luck with looking around at alternatives, as I finally dropped MTX after 18 months when my liver enzymes suddenly shot up. (Side note, Plaquenil can cause liver problems too, which I didn't realize so I am glad I dropped it too, after about 12 months on it for my non-existent lupus.) Too many drugs to try to keep up top of, too sick at times to care, and that stupid blind faith your doctor might watch this for you.

I started AP two months before dropping the MTX, and after another 2 months the Plaquenil. And after four months on AP that's when I suddenly developed this "wrinkled, shriveled" fingertips, then fingers, and palms. I had no idea my hands and wrists were so inflammed, as it just wasn't enough swelling for me to visually detect (with all my medical training in what inflammation looks like ha ha ), or the RD just never mentioned it. The recent MRIs of my wrists and hands confirmed the synovitis, first time its been mentioned and detected, and I had to ask the MRIs to be run.

(About six months before dx I told my endo I thought my ankles were swelling, and he looked and said he didn't see anything and put me on a dieuritic (sp). I took my hubbie with me after dx and finally looked him straight in the eye and asked how could you have such a desparately sick person in front of you for 18 months, dropping down to 102 lbs on your watch, and not even suggest anything was wrong? He never answered.) Never went back, and I don't have a thyroid anymore when I am becoming convinced it was inflammed and perhaps a trial of ABX first could have avoided complete removal).

The AP brought down my inflammation, thus the stretched skin from being swollen, then suddenly shriveling down to wrinkles. My primary and the dermatologist she sent me to both said "they had never seen anything like it before". Makes me wonder what the 4 RDs I saw thought about this inflammation, as not one had said I was swollen. These kind of statements or non-statements are the ones that make me realize how much about RA is not understood or recognized by the patient or the doctor.

I should have guessed when my wedding ring suddenly fell off my finger, but as a women, monthly bloat and fingers swelling up and down is taught as a lifestyle, not as a symptom of a disease.

All I know is that the AP caused the inflammation to go down dramatically, even though I was totally unaware my hands were swollen, plus I don't feel sick or fatigued anymore. That is really all I wanted when I first got sick over 7 years ago now.

And now I am looking at eye biopsies for possible cancer of the eye. I am afraid that all the rhetoric and studies posted above cannot convince me that MTX, Plaquenil, etc. do not harm us too, and I was fully inforned it was chemotherapy, that's pretty toxic. And I respect everyone who has had success with these drugs and no side effects, but that's not what happened to me. MTX and Plaquenil cannot be expected to work perfectly 100% of the time for 100% of the patients taking it - an impossibility anyone in here with any stats or science under their belt would understand from their training.

IMHO - good luck, keep us informed. Cathy

Wow, JSNM, that's some story. At this point you must be so disgusted with the medical profession in general. This DX sure was a wake-up call for me. I was shocked to learn how much doctors just don't know about this disease. When I told my RD at my last visit that I was feeling nearly normal he was very happy but admitted his recommended therapy was "a shot in the dark." Great, that really built my confidence. Now that I'm getting worse again and have to bump up the MTX, I'm ready to explore other options.

In doing my research so far, I saw that some doctors think the herpes virus could be the culprit for some in the infection process. That certainly rings a bell for me. I've joined the Road Back forum and expect to have some good information to take to my next appointment. Right now I feel like I want to push the RD harder about AP but I've already gotten the name of a couple of local doctors who may be able to help me out. My next appointment isn't for several more weeks so I have time to learn my stuff.

MTX and Increased Risk of All Cancers? | Arthritis Information