Cancer Risk in MS

Few conversations in the MS clinic generate as much anxiety as the one about cancer. Disease-modifying therapy labels carry explicit malignancy warnings, and patients understandably arrive asking whether the drug meant to protect their brain might be putting the rest of their body at risk. What often goes unsaid is the other half of the story: several of the medications now used in MS started out as cancer drugs. Rituximab was a cornerstone of treatment for B-cell lymphoma, and cladribine was first approved for hairy cell leukemia. The relationship between MS therapy and cancer runs in both directions, and the warning labels tell only one side of it.

This episode works through what the evidence actually shows. We discuss the mechanisms behind cancer risk with common MS therapies, how a country that has tracked its entire MS population since 1956 can answer questions no three-year trial could, and what 34,000 patients followed for life reveal now that most are on high-efficacy therapy. The conversation also dives into why absolute numbers change the discussion, which screenings belong on the calendar for which drug classes, the symptoms too easily written off as MS, why oncologists often advise staying on B-cell therapy after a cancer diagnosis, and long-term data showing newly diagnosed patients keeping their mobility and their jobs far longer than the generation before them.

This episode is sponsored by TG Therapeutics.

Jameson Holloman MD, neurologist at The MS Center for Innovations in Care, interviews:

Esther Melamed MD PhD

Esther Melamed MD PhD is a board-certified neurologist, Associate Professor of Neurology, and Associate Chair for Research in the Department of Neurology at Dell Medical School at the University of Texas at Austin. She completed her MD and PhD through the Medical Scientist Training Program at UCLA and her neuroimmunology training in California before founding the Multiple Sclerosis and Neuroimmunology Clinic at Dell Seton Medical Center. As principal investigator of a research group at UT Austin, she studies how genetic, environmental, and sex differences shape neuroinflammatory disease and how treatment can be tailored to the individual patient. In 2020 she led a comprehensive review of the relationship between MS disease-modifying therapies and cancer, the work that anchors much of this conversation.

Melinda Magyari MD PhD

Melinda Magyari MD PhD is a senior consultant neurologist at the Danish Multiple Sclerosis Center at Rigshospitalet, associate professor of neurology at the University of Copenhagen, and director of the Danish Multiple Sclerosis Registry, the world’s oldest and one of the most comprehensive MS clinical databases, holding complete national data collected since 1956. Her research draws on nationwide population-based data to examine MS epidemiology, sex differences, comorbidities, reproductive health, socioeconomic outcomes, and the real-world effectiveness and safety of disease-modifying therapies, including the largest post-authorization safety study of teriflunomide. Her work has helped clinicians and patients around the world understand the true long-term impact of MS treatment on cancer risk.