The high-risk factors related to HBV reactivation during chemotherapy include lymphoma, hematopoietic stem cell transplantation (HSCT), treatment regimen containing rituximab, a high HBV viral load before chemotherapy and baseline prechemotherapy HBeAg positivity. However, the role of antiviral prophylaxis in preventing HBV reactivation in patients with non- hepatocellular carcinoma (HCC) solid tumor and lower HBV DNA titer is unclear.
Between January 2011 and March 2018, all HBsAg seropositive patients with solid tumor receiving cytotoxic chemotherapy were retrospectively evaluated. The titer of HBV DNA and liver function were routinely examined before chemotherapy. The patients whose titer of HBV DNA was under 100 IU/ml were eligible. HBV reactivation, hepatotoxicity and disruption of chemotherapy attributed to HBV reactivation were compared according to antiviral prophylaxis.
Of 170 consecutive patients eligible for, 102 were treated without antiviral prophylaxis and 68 received antiviral prophylaxis. 55 patients were treated with entecavir, 7 for lamivudine and 6 for adefovir. The two groups were comparable in most clinical baseline characteristic including gender distribution, age, tumor types, tumor stage, the use of prednisone and/or anthracyclines. There was no significant difference between the two groups (P = 0.587). Patients without antiviral prophylaxis had a similar prevalence of HBV reactivation (6.8% vs 4.4%, P = 0.741) and severe hepatitis attributable to reactivation (4.9% vs 4.4%, P = 0.882). No patients died ultimately from fulminant hepatitis. Furthermore, no significant difference in disruption of chemotherapy was noted between patients with or without antiviral prophylaxis (3.9% vs 4.4%, P = 0.875).
For patients with non-HCC solid tumors and the titer of HBV DNA less than 100IU/ml before chemotherapy, antiviral prophylaxis failed to further reduce the reactivation of HBV. For such patients, regular monitoring of HBV viral load maybe more reasonable and cost-effective optimal choice.
Clinical trial identification
Legal entity responsible for the study
Clinical research Ethics Comittee of Tianjin Medical University General Hospital and National Cancer Hospital.
Has not received any funding.
All authors have declared no conflicts of interest.