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Hepatitis B virus management to prevent reactivation after chemotherapy: a review

  • Review Article
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Supportive Care in Cancer Aims and scope Submit manuscript

An Erratum to this article was published on 27 January 2013

Abstract

Purpose

Reactivation of hepatitis B virus (HBV) infection after chemotherapy can lead to liver failure and death. Conflicting recommendations regarding HBV screening in cancer patients awaiting chemotherapy mean that some patients at risk for HBV reactivation are not being identified and treated with prophylactic antiviral therapy.

Methods

We performed a narrative review of the existing evidence regarding screening for and management of HBV infection among patients with cancer using Ovid Medline, PubMed, and the Cochrane Library.

Results

Our review showed inconsistencies in the definition and management strategies for HBV reactivation. The timeframe of reactivation is variable, and its molecular mechanisms are not clear. There are five effective antiviral agents that can be used as prophylaxis to prevent reactivation of HBV infection in cancer patients; however, the optimal drug and duration of therapy are unknown. Reactivation is more commonly reported in patients with hematologic malignancies receiving rituximab treatment, but reactivation can occur after other chemotherapies and in patients with solid tumors. Screening with all three screening tests—HBsAg, anti-HBc, and anti-HBs—allows the most thorough interpretation of a patient’s serologic profile and assessment of reactivation risk; however, decision-making and cost-effectiveness studies are needed to determine optimal screening strategies.

Conclusions

Prevention of reactivation of HBV infection depends on identification of patients at risk and initiation of antiviral prophylaxis, but data to guide screening and treatment strategies are lacking. Additional research is necessary to accurately define and predict reactivation, identify best antiviral treatment strategies, and identify cost-effective HBV screening strategies.

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Acknowledgments

We are grateful to the following individuals at MD Anderson Cancer Center: Angelic Castillo, Department of General Internal Medicine, for administrative assistance; Laurissa Gann, MSLS, Research Medical Library, for assistance with literature review; and Stephanie Deming, BA, Department of Scientific Publications, for editing the manuscript.

Conflict of interest disclosures

Drs. Hwang, Vierling, Zelenetz, and Loomba served on an Advisory Board for reactivation of HBV infection for Gilead Sciences. Dr. Hwang has received research support from Bristol-Myers Squibb. Dr. Vierling has received research support from and serves as a Scientific Advisor for Gilead Sciences, Bristol-Myers Squibb, Roche, and Merck. Dr. Zelenetz serves as a Scientific Advisor for Gilead Sciences, Roche/Genentech, and GlaxoSmithKline. Dr. Loomba has received research support from Daiichi Sankyo and is a Scientific Advisor for Gilead Sciences and Gene Probe.

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Authors and Affiliations

  1. The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jessica P. Hwang & Susan C. Lackey

  2. Baylor College of Medicine, Houston, TX, USA

    John M. Vierling

  3. Memorial Sloan-Kettering Cancer Center, New York City, NY, USA

    Andrew D. Zelenetz

  4. The University of California San Diego, La Jolla, CA, USA

    Rohit Loomba

  5. Department of General Internal Medicine, 1515 Holcombe Blvd., Unit 1465, Houston, TX, 77030, USA

    Jessica P. Hwang

Authors
  1. Jessica P. Hwang
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  2. John M. Vierling
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  3. Andrew D. Zelenetz
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  4. Susan C. Lackey
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  5. Rohit Loomba
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Corresponding author

Correspondence to Jessica P. Hwang.

Additional information

Supported by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant, CA016672. Dr. Hwang is a recipient of a National Cancer Institute Career Development Award (K07CA132955). Dr. Loomba is supported by the American Gastroenterological Association Foundation-Sucampo-ASP Designated Research Award in Geriatric Gastroenterology, National Institute of Diabetes and Digestive and Kidney Diseases Career Development Award (K23DK090303), and a T. Franklin Williams Scholarship Award. Dr. Loomba is also supported by Atlantic Philanthropies, Inc, the John A. Hartford Foundation, the Association of Specialty Professors, and the American Gastroenterological Association. The content is solely the responsibilities of the authors and does not necessarily represent the official views of the funding agencies.

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Hwang, J.P., Vierling, J.M., Zelenetz, A.D. et al. Hepatitis B virus management to prevent reactivation after chemotherapy: a review. Support Care Cancer 20, 2999–3008 (2012). https://doi.org/10.1007/s00520-012-1576-7

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