Treatment of lupus and cervical cancer

Women with systemic lupus erythematosus (SLE) have a heightened risk for cervical cancer when they have been treated with the immune-suppressing drug cyclophosphamide.Researchers from the University of Michigan Health System, USA, monitored the occurrence of a precancerous condition called cervical intraepithelial neoplasia, or CIN, over a 3-year period among in 61 women with lupus who were treated with injections of cyclophosphamide and/or azathioprine plus prednisone. Six women treated with cyclophosphamide alone or in combination with azathioprine developed CIN, the team reports in the Journal of Rheumatology, compared with none of the women treated with prednisone alone or azathioprine plus prednisone. Compared with the general population, the rate of CIN was three times higher for women with SLE who were given cyclophosphamide. Only two additional patients developed abnormal cervical smears in the following 4 years, neither of which showed CIN. The study did not look at whether the type of human papilloma virus (the cause of nearly all cases of cervical cancer) harboured by the women played into their risk for developing CIN. In general, certain virus subtypes are known to be more virulent than others. The next step to clarify the causal role of cyclophosphamide would be to serotype HPV in women starting treatment, the researchers concluded.

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