Post-cancer use of immune-modulating therapies in individuals with inflammatory bowel disease: a review of risks and recommendations

Background Patients with inflammatory bowel disease (IBD) and prior malignancy may face potential risks of incident or recurrent cancer when treated with systemic immune-modulating (IM) therapies. Aim To review evidence on cancer risks associated with IM therapies and propose a framework for IM therapy use following cancer diagnosis in individuals with IBD and prior malignancy. Methods A detailed PubMed search identified original studies and reviews published from January 1, 2000 to February 1, 2026 evaluating incident or recurrent cancers in individuals with IBD and prior malignancy treated with IM agents. Reference lists of relevant reviews were screened. Recommendations from international societies were summarized and practical guidance for post-cancer IM therapy use was developed. Results Of 149 identified articles, 16 met eligibility criteria. Current evidence does not demonstrate increased risks of new or recurrent cancers with IM therapies in the post-cancer setting, except for higher recurrence of non-melanoma skin cancer with thiopurines. Recommendations are largely extrapolated from overall cancer risk data and include avoiding thiopurines in patients with prior lymphoma, non-melanoma skin cancer, or cervical cancer; avoiding anti-TNF agents in those with prior lymphoma or melanoma; and avoiding JAK (janus kinase) inhibitors for at least 5 years following cancer diagnosis. Evidence for newer IM therapies remains limited. Conclusion Available evidence does not suggest increased risks of incident or recurrent cancers with IM therapies in individuals with IBD after cancer, although data are limited. Treatment decisions should be individualized, involving multidisciplinary discussion and consideration of cancer recurrence risk.