JOMS study: Immunosuppressant drugs raise risks for oral cancer patients

ROSEMONT, Ill. – Patients with oral squamous cell carcinoma taking immunosuppressant drugs – with or without steroids – should be closely monitored because of increased risk for developing other tumors, according to a study published in the September issue of the Journal of Oral and Maxillofacial Surgery.

A 10-year retrospective study at the Division of Oral and Maxillofacial Surgery at the Tokyo Medical and Dental University analyzed the charts of oral cancer patients on immunosuppressant therapies, which are used to treat those with organ transplants or autoimmune diseases such as rheumatoid arthritis.

Researchers found these patients were more susceptible to developing secondary cancers in lymph nodes in their neck and distant organs, resulting in a notably poorer five-year survival rate.

These findings “must be kept in mind when determining their treatment regimen, and the treatment courses of such patients must be closely monitored,” the authors said.

The authors concluded in the official journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS) that patients with stage I and II tumors should undergo elective dissection of their cervical (neck) lymph nodes and be carefully monitored. Patients with stage III and IV tumors should undergo postoperative chemotherapy or chemoradiotherapy – a combination of chemo and radiation – and their immune status should be monitored.

Another JOMS study published in July shows oral squamous cell carcinoma accounts for more than 90 percent of all oral cancers and can be caused by external factors such as tobacco or alcohol use and intrinsic factors such as genetics, nutritional deficiencies and the patient’s immunologic status.

About 43 percent of the patients on immunosuppressant therapy – who ranged in age from 44 to 83 – were diagnosed with secondary cancer in single or multiple neck lymph nodes, and about 14 percent were diagnosed with cancer in distant organs such as the liver and lungs.

Oral cancer patients not on immunosuppressant or steroid therapy experienced secondary cancers at lower rates – 29.2 percent for neck lymph nodes and about 4 percent for distant organs.

The authors of “Clinical Course of Oral Squamous Cell Carcinoma in Patients on Immunosuppressant and Glucocorticoid Therapy” are Hideaki Hirai, DDS, PhD; Hirofumi Tomioka, DDS, PhD; Yumi Mochizuki, DDS, PhD; Yu Oikawa, DDS; Fumihiko Tsushima, DDS, PhD; and Hiroyuki Harada, DDS, PhD.

The full article can be accessed at