Hepatitis B virus management to prevent reactivation after chemotherapy: a review

Hwang, Jessica P.; Vierling, John M.; Zelenetz, Andrew D.; Lackey, Susan C.; Loomba, Rohit

doi:10.1007/s00520-012-1576-7

Cited by 35 publications

(52 citation statements)

References 104 publications

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“…Worldwide, chronic HBV infection is very common 7 and importantly a high proportion of patients with current or past HBV infection are unaware of the infection, 8 so it is important to screen all patients who receive immunosuppression/ chemotherapy. 9 In this case, HBV screening was undertaken before starting R-CHOP and the patient was anti-HbcAb positive, but HBsAg negative, in keeping with past infection. The decision was made to monitor for reactivation with LFTs, HBsAg and HBV DNA testing during chemotherapy, as per the guidelines of the European Association of the Study of the Liver (EASL).…”

Section: Discussionmentioning

confidence: 86%

“…9 Therefore, ongoing monitoring of patients is essential after chemotherapy, even if they are started on antiviral therapy.…”

Section: Discussionmentioning

confidence: 99%

“…There are many immunosuppressive and chemotherapeutic agents and the absolute risk of HBV reactivation varies with specifi c regimens, 9,11 although few studies have assessed risks with specifi c agents. Overall, studies suggest a reactivation rate of approximately 50% for HBsAg-positive patients receiving chemotherapy for lymphoma and 15% for solid tumours.…”

Section: Discussionmentioning

confidence: 99%

“…17,18 More intensive immunosuppressive regimens, particularly those including rituximab and/or high-dose steroids, are the highest risk. 9,11 Recent studies suggest that reactivation rates in anti-HBcAb-positive patients treated with rituximab are 25%. 19,20 The clinical signifi cance of HBV reactivation can be variable, ranging from a mild transaminitis to liver failure and death.…”

Section: Discussionmentioning

confidence: 99%

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Lesson of the month 2: Severe reactivation of hepatitis B after immunosuppressive chemotherapy

2014

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Section: Discussionmentioning

confidence: 86%

“…9 Therefore, ongoing monitoring of patients is essential after chemotherapy, even if they are started on antiviral therapy.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Lesson of the month 2: Severe reactivation of hepatitis B after immunosuppressive chemotherapy

2014

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“…The risk of reverse seroconversion is clearly significantly increased with the use of rituximab or myeloablative chemotherapy (bone marrow transplantation) and appears to be higher with anti-TNF therapy as well. 25 Although antiviral therapy is likely effective in this setting, data supporting this approach are lacking. As a result, uncertainty remains about the best management strategy for this relatively large group of patients.…”

Section: Management Of Anti-hbc-positive Patientsmentioning

confidence: 99%

HBV treatment in a patient who will be receiving immunosuppressive therapy

Feld

2013

Clinical Liver Disease

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Despite an effective vaccine, hepatitis B virus (HBV) infection remains an enormous global public health problem with up to 400 million people chronically infected and as many as 2 billion people with evidence of exposure to the virus worldwide. 1,2 The virus is noncytopathic, with hepatic injury occurring as a result of the host immune response against the virus. 1 As a result, the interaction between HBV and the immune system is critical in determining the outcome of infection.After perinatal or early childhood infection, >90% of individuals will progress to chronic infection, initially characterized by normal liver tests and histology despite high levels of HBV replication, the so-called immunotolerant phase of infection. 2 Patients eventually develop an immune response against HBV, leading to flares of hepatitis with the potential for progressive liver damage. Ultimately, most immunocompetent patients will gain immune control of HBV, with suppression of viral replication, normalization of liver enzymes, and loss of circulating HBeAg. 2 Persistence of this inactive carrier state depends on immune function. Even those with undetectable HBV DNA in the serum continue to harbor replication-competent HBV in infected liver cells. With immunosuppression, immune control may be lost, resulting in reactivation of HBV replication with the potential for severe flares of hepatitis, often at the time of restoration of immune function. Reactivation has variable clinical consequences ranging from asymptomatic increases in serum HBV DNA to potentially fulminant and even fatal flares of hepatitis. 3,4 Reactivation may also lead to interruptions or premature discontinuation of immunosuppressive therapy, including cancer chemotherapy with potential negative consequences. 5

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Hepatitis B infection reported with cancer chemotherapy: analyzing the US FDA Adverse Event Reporting System

et al. 2018

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We conducted data mining using the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database on spontaneously reported adverse events to evaluate the association between anticancer drug therapy and hepatitis B infection. Reports of hepatitis B infection were retrieved from the FAERS database. The reporting odds ratio (ROR) was used to estimate the association between hepatitis B infection and various anticancer agents and drug combinations. We detected statistically significant risk signals of hepatitis B for 33 of 64 anticancer agents by ROR (26 cytotoxicity drugs and seven molecular‐targeted drugs). We focused on molecular‐targeted drugs and assessed the risk of hepatitis B from specific anticancer drug combinations. The frequency of hepatitis B infection was significantly high for drugs such as rituximab, bortezomib, imatinib, and everolimus. The addition of cyclophosphamide, doxorubicin, and fludarabine to drug combinations additively enhanced the frequency of hepatitis B infection. There were no reports on hepatitis B infection associated with trastuzumab or azacitidine monotherapy. However, trastuzumab‐containing regimens (e.g., combinations with docetaxel or paclitaxel) were correlated with the incidence of hepatitis B infection, similar to azacitidine monotherapy. Our findings suggest that the concomitant use of anticancer drugs, such as trastuzumab, taxane, and azacitidine, may contribute to the risk of hepatitis B infection. The unique signals detected from the public database might provide clues to eliminate the threat of HBV in oncology.

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Hepatitis B virus management to prevent reactivation after chemotherapy: a review

Cited by 35 publications

References 104 publications

Lesson of the month 2: Severe reactivation of hepatitis B after immunosuppressive chemotherapy

Lesson of the month 2: Severe reactivation of hepatitis B after immunosuppressive chemotherapy

HBV treatment in a patient who will be receiving immunosuppressive therapy

Hepatitis B infection reported with cancer chemotherapy: analyzing the US FDA Adverse Event Reporting System

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