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Exacerbation may occur in HBsAg-positive patients undergoing chemo without antiviral prophylaxis

According to study findings published in PLoS One, researchers found that cancer patients positive for hepatitis B surface antigen who underwent chemotherapy without adequate antiviral prophylaxis were at risk for severe acute exacerbation.

“Currently, the exact severe acute exacerbation rates of chronic hepatitis B virus infection in [hepatitis B surface antigen]-positive cancer patients with various solid tumors receiving chemotherapy have rarely been systemically assessed,” the researchers wrote. “In addition, most studies investigating flare-up of HBV infection in cancer patients receiving chemotherapy dealt with reactivation of HBV infection but not clinically significant acute exacerbation events. … We [investigated] the incidence of severe acute exacerbation of chronic HBV infection [among] these patients with a variety of solid tumors and hematological malignancies.”

Researchers conducted a retrospective review using data from 156 patients with cancer and positive for hepatitis B surface antigen (HBsAg) between July 2007 and January 2013. Of the patients, 16 had hematological malignancies and 140 had solid tumors. All of the patients underwent systemic intravenous or oral chemotherapy during this time period and did not receive antiviral prophylaxis. None of the patients with solid tumors received rituximab-containing chemotherapy. Among the hematological malignancy patients, 62.5% received chemotherapy containing rituximab. The primary outcome was severe acute exacerbation of HBV infection, according to the research.

Among this cohort, 68.9% of the patients were male (n = 107) and 31.4% were female (n = 49). A majority of the patients with hematological malignancies (81.3%) and nonhepatocellular carcinoma solid tumor had normal alanine aminotransferase (ALT) serum at the beginning of chemotherapy. However, only 20.5% of the patients with HCC had normal ALT serum before chemotherapy.

Overall, severe acute exacerbation of HBV occurred in 25% of patients with hematological malignancy (4/16) and 4.3% of patients with solid tumor (6/140; P = .005). Of the 16 with hematological malignancy, 25% developed liver decompensation due to severe acute exacerbation of HBV and 18.7% died in fatal HBV reactivation. In addition, delayed chemotherapy due to HBV flare-up occurred in 31.3% of the patients, according to the research.

Among the patients with solid tumors, the incidence rate of severe acute exacerbation of chronic HBV in HCC was 2.3%; 4% for colorectal cancer; 7.1% for lung cancer; 9% for breast cancer; 16.7% for gynecological cancer; 6.7% for urological tract cancer; and 0% for head/neck cancer and other solid malignancies.

Patients who underwent chemotherapy with rituximab had a higher incidence of acute exacerbation compared with patients without rituximab-containing chemotherapy (P = .001).

Univariate analysis showed malignancy type and chemotherapy type to be associated with severe acute exacerbation of HBV.

The researchers concluded: “Severe acute exacerbation of chronic HBV infection may occur in HBsAg-positive patients with a variety of solid tumors who received chemotherapy without adequate antiviral prophylaxis.”

Disclosures: The researchers report no relevant financial disclosures.