Regarding malignancy, thiopurine monotherapy or anti-TNF monotherapy is associated with a small risk of lymphoma.15 When used in combination, some papers report an increased risk compared to monotherapy.16–18 This has not been seen with ustekinumab or vedolizumab.19–21 Furthermore, recent data suggest that ustekinumab and vedolizumab do not pose an increased risk of new or recurrent cancer in patients with a previous history of malignancy.22 These agents may be preferred in patients at high risk or with a history of malignancy. The gene discussed is TNF; the disease is cancer.