Liver Dysfunction: Chemotherapy in Patients with Current or Resolved Hepatitis B Viral Infection

Abstract

Liver dysfunction is caused by a variety of anticancer drugs and their metabolites. Among the liver dysfunctions, rapid growth of hepatitis B virus (HBV) is classified as HBV reactivation. HBV reactivation is most frequently found in patients ( pts) with hepatitis B surface antigen positivity [sAg(+)], however, it has been reported even in HBsAg-negative pts positive for hepatitis B core antibody or hepatitis B surface antibody [c/sAb(+)], who are thought to have had transient infections and to have been cured. In Japan, 1{%}-3{%} of pts undergoing chemotherapy are sAg(+), and approximately 20{%}-30{%} are c/sAb(+). Therefore, caution regarding reactivation of hepatitis viruses following chemotherapy is needed in these pts. In the Japanese guidelines for HBV reactivation, prophylactic administration of the antiviral drug entecavir for sAg(+) pts is recommended, and periodic monitoring of HBV DNA and deferred preemptive administration of antiviral drugs after conversion to HBV DNA positivity is recommended in c/sAb(+) pts. In a prospective cohort study of 379 pts carried out to investigate the incidence and outcome of HBV reactivation in patients with solid tumors, HBV reactivation occurred in 9 (25.7{%}) of 35 sAg(+) pts and 7 (2.0{%}) of 344 c/sAb(+) pts. There were no pts with increased serum transaminase levels or fulminant hepatitis in this series. In a prospective observational study for malignant lymphoma following rituximab-containing regimens, HBV reactivation occurred in 16 (8.6{%}) out of 187 analyzed patients with resolved HBV infection in the interim analysis, however, no HBV-related hepatitis was observed. Therefore, the usefulness of pre-emptive antiviral drug therapy in c/sAb pts was elucidated by these two studies. However, numerous issues regarding HBV reactivation, including the optimal method of management, have not yet been fully clarified. Development of a strong evidence of HBV reactivation following chemotherapy is anticipated in the future.