Abstract
Background. Anti-TNF (tumor necrosis factor) agents exhibit remarkable clinical efficacy in treating chronic inflammatory diseases, including rheumatoid arthritis (RA). Although there has been some concern that anti-TNF agents may increase the risk of malignancy, a unified consensus has not been obtained as to whether anti-TNF agents are carcinogenic. Case. A 77-year-old female ex-smoker (23 pack-years) was diagnosed with RA in 2004. Prednisolone and disease-modifying antirheumatic drugs (DMARDs) were administrated starting in 2004, with anti-TNF agents added in 2009. Chest CT performed in May 2012 revealed a large tumor occupying the right lower lobe of the lung, and, after a further examination, a diagnosis of small cell lung cancer (cT3N3M1b, stage IV) was confirmed. Following the withdrawal of the anti-TNF agents, combination chemotherapy with carboplatin (CBDCA) and etoposide (ETP) was administered for a total of five courses. The curative effect was a good partial response, and the patient's performance status improved from 3 to 1. However, she was unable to continue the chemotherapy due to hematological adverse events, and she died eight months after disease onset. Conclusions. We herein reported a case of small cell lung cancer in a patient with RA that developed during the administration of anti-TNF therapy. Chemotherapy achieved a remarkable response; however, the patient ultimately died eight months after disease onset. With respect to the risk of malignancy, we strongly recommend providing careful observation in cases involving the use of anti-TNF agents in RA patients, particularly elderly subjects and those with a history of smoking.
