French recommendations for assessing and managing the risk of cancer before the initiation of targeted therapies for chronic rheumatic inflammatory diseases.

Objective: Chronic inflammatory rheumatic diseases (CIRDs) are associated with a higher risk of cancer due to persistent inflammation, immune dysregulation, and immunomodulatory therapies. The growing use of targeted therapies necessitates systematic cancer risk assessment prior to treatment initiation.

Objective: To develop practical recommendations for cancer risk assessment and management before initiating targeted therapies in patients with CIRDs, while balancing therapeutic benefits with oncologic safety.

Methods: Conducted under the French Society of Rheumatology, this initiative followed standardized procedures. A multidisciplinary task force was established, including rheumatologists, oncologists, pulmonologists, gynecologists, and patient representatives. Two systematic literature reviews (2005-2024) were performed to assess cancer risk in CIRD patients under conventional and targeted DMARDs. Recommendations were formulated based on evidence synthesis and expert consensus, with multiple voting rounds to establish levels of agreement.

Results: The task force proposed three overarching principles and eight evidence-based recommendations. It advocated the application of general population cancer screening programs, adapted to the specific needs of immunocompromised patients with CIRDs. These adaptations may involve earlier and/or more frequent screening. Recommendations also support systematic risk assessment before initiating therapies, reinforced preventive strategies like HPV vaccination and smoking cessation, and at least one dermatologic evaluation during follow-up. Decisions regarding higher-risk therapies, such as JAK inhibitors and abatacept, should involve multidisciplinary discussions.

Conclusion: These recommendations provide a practical, individualized framework for cancer risk assessment in CIRD patients. By integrating adapted screening, prevention, and shared decision-making, they aim to optimize patient safety while preserving disease control.