. 2018 Oct 12;25(5):831–842. doi: 10.1093/ibd/izy313

Table 3.

Suggested Management of Biologics in the Setting of Active Malignancy

Therapeutic Target	Non-Cutaneous		Cutaneous
Therapeutic Target	Solid Tumor	Lymphoma	Non-Melanoma (Squamous Cell, Basal Cell)	Melanoma
TNF	Continue Stop if cytotoxic chemo or metastatic^a	Stop-Treat, then Individualize: Restart vs Switch to non-anti-TNF	Continue	Stop-Treat Switch to non-anti-TNF
Integrin	Continue	Continue	Continue	Continue
IL12/23	Continue Stop if cytotoxic chemo or metastatic^a	Continue Stop if cytotoxic chemo^a	Continue	Hold if chemo^a
JAK	Continue Stop if cytotoxic chemo or metastatic^a	Continue Stop if cytotoxic chemo^a	Continue, but monitor	Hold if chemo^a

IL: interleukin; JAK: Janus kinase

^aIf stopping biologic during chemotherapy, we recommend monitoring for rebound IBD flare once the chemotherapy is stopped.

For checkpoint inhibitors in patients without preexisting IBD, anti-TNFs and vedolizumab have been successfully used for treatment of checkpoint inhibitor-induced colitis. It is currently unknown how checkpoint inhibitors will influence underlying IBD, and thus, we recommend discussion with the treating oncologist and close clinical observation during therapy. In IBD patients not yet receiving biologics who develop worsening inflammation on checkpoint inhibitors, we recommend anti-TNF or vedolizumab therapy.