Oropharyngeal carcinoma arising after methotrexate and etanercept therapy for rheumatoid arthritis

doi:10.1016/j.oooo.2013.11.499

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Volume 117, Issue 3, March 2014, Pages e261-e263

https://doi.org/10.1016/j.oooo.2013.11.499 Get rights and content

Etanercept is an anti–tumor necrosis factor α receptor agent used to treat inflammatory conditions. Previous reports described rapid development of skin squamous cell carcinoma (SCC) after etanercept use. This report describes a novel case of oropharyngeal SCC associated with the use of etanercept. A 45-year-old man with rheumatoid arthritis developed oropharyngeal pain within 2 months after the start of etanercept therapy and was diagnosed with tonsillar carcinoma. This patient had other exposures that increase the risk of oropharyngeal cancer, such as tobacco and alcohol use. However, owing to the timing of onset of his initial symptoms, etanercept should be considered as a possible factor in the etiology or progression of his tumor, especially in the context of reported skin SCC after etanercept therapy in patients at risk for SCC. Clinicians should be alert to signs of malignancy in patients on etanercept, particularly those at high risk for skin or head and neck cancers.

Section snippets

Case Report

In January 2011, a 45-year-old man with a chief complaint of severe pain and ulceration in the left oropharyngeal region was referred to the oral medicine clinic at the University of California, San Francisco, by his rheumatologist.

The onset of oral pain was in October 2010, and the severe intensity of the discomfort was unchanged over the 3-month period. He had a history of rheumatoid arthritis and had been on methotrexate (20 mg/wk) since June 2010 and etanercept (50 mg/wk) and prednisone (10

Discussion

Clinical trials have found that etanercept is a generally well-tolerated anti-TNF drug.1, 2, 3, 4 The most commonly described adverse effects with short-term use include injection site reactions, skin rash, and increased susceptibility to infection.1, 2, 3, 4 A 7.0% incidence of serious infections such as pneumonia in patients receiving etanercept alone or in combination with methotrexate for treatment of rheumatoid arthritis after 2 years of therapy has been reported.² A 2006 article reporting

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There are more references available in the full text version of this article.

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Another meta-analysis found an increased risk of developing only nonmelanoma skin cancers.40 There are some case reports that suggests an association between anti- TNF and malignancy or premalignant lesions.41–43 Drug eruptions involving oral mucosa vary and may manifest as a lichenoid reaction, vesicle/bullae, or ulcer (Fig. 6).44,45
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Oral medicineOnline only articleOropharyngeal carcinoma arising after methotrexate and etanercept therapy for rheumatoid arthritis

Section snippets

Case Report

Discussion

J Am Acad Dermatol

J Am Acad Dermatol

Biological insights from clinical trials with anti-TNF therapy

Spring Semin Immunopathol

Etanercept: a review of its use in the management of rheumatoid arthritis

Drugs

A trial of etanercept, a recombinant tumor necrosis factor receptor:Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate

N Engl J Med

Tofacitinib or adalimumab versus placebo in rheumatoid arthritis

N Engl J Med

Oral medicine
Online only article
Oropharyngeal carcinoma arising after methotrexate and etanercept therapy for rheumatoid arthritis