Reactivation of Hepatitis B Virus after Withdrawal of Erlotinib

Abstract

Reactivation of hepatitis B virus (hbv) is a reported complication for patients undergoing chemotherapy, particularly immunochemotherapy with anti-CD20 agents such as rituximab. However, as the use of molecularly targeted agents increases, the risk of viral reactivation is less clearly defined. Here, we present the case of a 62-year-old woman with newly diagnosed EGFR mutation-positive metastatic non-small-cell lung cancer (nsclc).Per interview, our patient had a remote history of hbv infection. She was started on erlotinib and developed profound diarrhea leading to renal failure that required hospital admission and temporary discontinuation of erlotinib. At 8 days after erlotinib cessation, she had a marked spike in her liver function tests, with viral serologies that were consistent with hbv reactivation. Although erlotinib and other tyrosine kinase inhibitors (tkis) are not classically associated with hbv reactivation, hbv reactivation can occur even in the setting of tki withdrawal. Before tki initiation, careful patient screening in those at risk for hbv should be performed to attenuate preventable hepatotoxicity and to differentiate between other causes of hepatotoxicity (for example, drug-induced toxicity).

Chemotherapy: oral side effects and dental interventions. A review of the literature

“…[2] Other side effects aredefects in spermatogenesis (frequently observed in chemotherapy), [10] nausea and vomiting (two of the most frequent side effects of chemotherapy), [11] fatigue (common symptom present during chemotherapy), diarrhea, [1] handfoot syndrome (Palmar-plantar erythrodysesthesia, acral erythema or Burgdorf reaction), [12] cardiotoxicity (commonly observed after chemotherapy) (associated with both older and newer therapies which may lead to left ventricular impairment or congestive heart failure, or they can cause hypertension. Additionally, thromboembolism, pericardial thickening or cardiac arrhythmias), [13] reactivation of hepatitis B, [14] neurologic complications (neurotoxicity after chemotherapy includes seizures, peripheral and cranial neuropathy, myelopathy, aseptic meningitis, cerebellar syndrome, stroke, and encephalitis). [15][16][17] Notably chemotherapyinduced peripheral neuropathy (CIPN) is possible to engage oral cavity and other sites simultaneously.…”

The Risk of Herpes Zoster in Patients with Non-small Cell Lung Cancer according to Chemotherapy Regimens: Tyrosine Kinase Inhibitors versus Cytotoxic Chemotherapy

“…Despite the expectation that EGFR TKIs would be less toxic to immune-related cells, there have been a few cases of viral infection or viral reactivation upon EGFR TKI use. Wnorowski et al [11] described a patient who developed a severe skin eruption followed by herpes zoster superinfection upon erlotinib use, and Bui and Wong-Sefidan [13] reported hepatitis B virus reactivation after erlotinib withdrawal. However, there also have been various studies showing that EGFR TKIs have anti-viral effects against human papillomavirus (HPV), hepatitis C virus (HCV), and poxvirus [14-18].…”

Can a metabolism-targeted therapeutic intervention successfully subjugate SARS-COV-2? A scientific rational

“…As outlined in Table 1 [ 18 , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] , [93] , [94] , [95] , [96] , [97] , [98] , [99] , [100] , [101] , [102] , [103] , [104] , [105] , [106] , [107] , [108] , [109] , [110] , [111] , [112] , [113] , [114] , [115] , [116] , [117] , [118] , [119] , [120] , [121] , [122] , [123] , [124] , [125] , [126] ,…”