Hepatitis B virus reactivation risk varies with different chemotherapy regimens commonly used in solid tumours

Abstract

Background:Hepatitis B virus (HBV) reactivation may occur with chemotherapy and has significant morbidity and mortality. The United States Centre for Disease Control and Prevention recommends pre-chemotherapy hepatitis B screening for all cancer patients, while the American Society of Clinical Oncology finds that there is insufficient evidence currently to support such a recommendation. Apart from anthracyclines, HBV reactivation rates from other commonly used chemotherapy regimens in solid tumours are not well described.Methods:We compared HBV reactivation risk in patients receiving several commonly used chemotherapy regimens for solid tumours associated with different immunosuppression risk at a tertiary cancer centre in an HBV endemic region.Results:A total of 1149 patients were identified, including 434, 196, 245 and 274, respectively, who received doxorubicin-based, oxaliplatin- or irinotecan-based, carboplatin/gemcitabine, and capecitabine chemotherapy. HBV screening rate was 39% overall. Thirty out of 448 (7%) screened patients were HBsAg positive and 28 out of 30 received prophylactic antiviral therapy with no reactivation. Three out of 1149 patients overall (0.3%) developed HBV reactivation, all from the unscreened doxorubicin group (3 out of 214, 1.4%). No unscreened patients (0 out of 487) in the other three treatment groups developed reactivation (P<0.001).Conclusion:Not all chemotherapy regimens result in HBV reactivation. Routine hepatitis B screening for low- or moderate-risk regimens may not be warranted.

Successful Treatment with Entecavir for Reactivation of Hepatitis B Virus Following Systemic Chemotherapy in a Hepatitis B Surface Antigen-negative Patient with Colorectal Cancer

“…Accordingly, many CRC patients have been treated with chemotherapy, but HBV reactivation in HBV-negative CRC patients following chemotherapy has not been described. Ling and colleagues reported that the risk of HBV reactivation is extremely low among CRC patients treated with oxaliplatin-based chemotherapy (10). The present report is the first known case of HBV reactivation in an HBsAgnegative individual who had undergone cytotoxic chemotherapy for CRC.…”

“…In CRC patients undergoing chemotherapy, the risk of HBV reactivation has been reported to be extremely low (10). In fact, there has been only one report of HBV reactivation during chemotherapy in a HBsAgpositive CRC patient (11), and no reports in HBs-negative patients.…”

Reactivation of Hepatitis B in a Patient with Breast Cancer Treated Using Capecitabine

“…About 20% of untreated HBsAg-positive patients with breast cancer undergoing chemoteraphy develop HBVr, in these studies anthracycline-based therapy was used by all investigators [5][6][7] and glucocorticoids were routinely administered in 2 studies. Despite in literature capecitabine does not result in acute hepatitis B reactivation [8] ; we report a case of HBVr leading to exitus in a female patient with breast cancer treated using capecitabine. About a year before the diagnosis of breast cancer, the patient suffered from bone pain.…”

Diagnosis, Management, and Prevention of Hepatitis B Reactivation

“…Whereas none of 28/30 patients receiving prophylactic antiviral therapy developed HBVr (p<0.001), 3/1149 developed HBVr (0.3 %), all three within the unscreened group receiving doxorubicin-based regimens (3/214), 1.4 %; none of 487 patients receiving nonanthracycline-based regimens developed HBVr [22].…”