Study explores impact of chemotherapy on HCV reactivation, flare

BOSTON — Although HCV reactivation occurred in approximately one-quarter of patients with cancer who were receiving chemotherapy, less than half of those patients experienced hepatitis flare, according to findings presented at The Liver Meeting 2016.

“These patients can be monitored. … In some cases they may have to dose reduce their chemotherapy but in general, we are telling oncologists to proceed with their chemotherapy,” Harrys A. Torres, MD, of the department of infectious diseases at the University of Texas MD Anderson Cancer Center, said during his presentation.

Torres and colleagues, suggested that reactivation of HCV has been reported among patients with cancer during chemotherapy. The current observational cohort study aimed to assess the incidence and clinical outcomes of HCV reactivation in a cohort of 100 consecutive patients with primary or metastatic cancer accrued at MD Anderson between November 2012 and June 2016.

The researchers measured HCV RNA and ALT levels during chemotherapy, according to the results. The parameter for reactivation was defined as an increase in HCV-RNA greater than or equal to 1 log¹⁰ IU/mL compared with baseline, while a hepatitis flare was defined as an increase of 3 or more times upper limit of normal (or >170 IU/ml) in ALT. Torres noted that 43 patients of the original 374 patients with cancer and HCV were excluded because they reached sustained virologic response prior to their initial clinic visit.

By this definition, reactivation occurred in 23 patients. This was a reactivation rate of 23% overall, of which 36% occurred in patients with hematologic cancers and 10% occurred in patients with solid tumors.

Adjusted multivariate analysis results indicated that predictors of reactivation included: use of rituximab (P < .0001), receipt of high-dose steroids (P = .001), purine analog (P = .02) and the alkylating agent bendamustine (P < .001). Torres said this is the first time a connection has been reported with ruxolitinib and HCV reactivation. He also linked platinum cancer therapy to a decrease in viral load (P = .02).

Five patients required a dose reduction of chemotherapy as a result of reactivation and flare. Liver failure or liver-related mortality did not occur within 6 months of chemotherapy.

Hepatitis flare occurred in 43% of the 23 patients who experienced reactivation (P = .006) and six patients out of those 23 had to discontinue cancer treatment due to hepatitis flare (P = .08). None of the patients with HCV reactivation fell to liver failure and mortality within 36 weeks of starting cancer treatment was similar in the reactivation group and the non-reactivation.

“HCV reactivation seemed to have an indolent course compared to hepatitis B. No patient died from liver-related events,” Torres said. “When you are approached by oncologist and they ask you can we do chemotherapy in your patient with hepatitis, please answer yes.” – Katrina Altersitz and Rob Volansky

Reference:

Torres HA, et al. Abstract 65. Presented at: The Liver Meeting; Nov. 11-15, 2016; Boston.

Disclosures: Torres reports consulting for Gilead Sciences, Janssen Pharmaceuticals, Vertex Pharmaceuticals; receiving grant or research Support from Gilead Sciences and Merck.