Cancer Chemother Pharmacol DOI 10.1007/s00280-015-2700-4
ORIGINAL ARTICLE
Hepatitis B virus reactivation and hepatitis in gastrointestinal cancer patients after chemotherapy Yu Yang · Yang Du · Wu‑Xia Luo · Cong Li · Ye Chen · Ke Cheng · Jing Ding · Yi Zhou · Jun Ge · Xian Yang · Ji‑Yan Liu
Received: 12 December 2014 / Accepted: 6 February 2015 © Springer-Verlag Berlin Heidelberg 2015
Abstract Purpose The objectives of this study were to investigate the incidences of hepatitis B virus (HBV) reactivation and hepatitis in gastrointestinal cancer patients with positive hepatitis B surface antigen (HBsAg) after chemotherapy and assess the effect of antiviral therapy on preventing HBV reactivation and hepatitis. Methods The medical records of gastric or colorectal cancer patients with positive HBsAg undergoing chemotherapy in West China Hospital were reviewed from January 2009 to August 2014. Results One hundred and fifty-six patients were included. Seventy-six patients had no records of the baseline HBV DNA copy (bHDC) and received no antiviral therapy. Of 80 patients with known bHDCs, 39 patients received antiviral therapy. The incidence of HBV reactivation was 14.6 % in the non-antiviral group with known bHDCs (n = 41), compared with 0 % in the antiviral group (P = 0.039). Compared with 12.8 % in the antiviral group (P = 0.034), 29.9 % of patients suffered from hepatitis in the total non-antiviral group (n = 117). More patients with moderate/severe hepatitis were seen in the non-antiviral group (P = 0.027). Non-antiviral therapy was the only risk factor for hepatitis in multivariate analysis (HR 3.195, 95 % CI 1.117–10.989; P = 0.043).
Yu Yang and Yang Du have contributed equally to this work. Y. Yang · Y. Du · W.‑X. Luo · C. Li · Y. Chen · K. Cheng · J. Ding · Y. Zhou · J. Ge · X. Yang · J.‑Y. Liu (*) Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, No. 37, Guo Xue Xiang, Chengdu 610041, Sichuan Province, China e-mail: [email protected]
Conclusions HBV reactivation and hepatitis occurred in a significant proportion of gastrointestinal cancer patients with positive HBsAg who received chemotherapy. Antiviral therapy could reduce the incidences of HBV reactivation and hepatitis. Keywords HBV reactivation · Hepatitis · Antiviral therapy · Gastrointestinal cancer · Chemotherapy
Introduction Hepatitis B is a global health concern, and of all chronically infected carriers worldwide, approximately 75 % are found in the Asia–Pacific regions. Among Chinese population aged over 3 years, the prevalence of hepatitis B surface antigen (HBsAg) is 9.09 % [1]. Reactivation of hepatitis B virus (HBV) is a well-recognized complication of antitumor chemotherapy for HBV carriers in some kinds of cancer. The clinical consequences are characterized by raised levels of serum HBV DNA and hepatotoxicity varying from asymptomatic elevation of transaminase to fatal hepatic failure. HBV reactivation had mainly been focused on patients with lymphoma because the high incidence was up to 21–73 % [2–6]. The incidence of HBV reactivation was also reported to range from 21 to 46 % in patients with breast cancer [7–9]. Anthracycline and corticosteroids as parts of the chemotherapeutic combination or premedication were both usually involved in treatment of lymphoma and breast cancer. These two drugs were found to increase the risk of HBV reactivation [10–14]. To date, the data of HBV reactivation for other solid tumors were so far limited. Gastrointestinal cancer is the most common malignant tumor of digestive tract, and the incidences of colorectal and gastric cancer rank the third and fourth worldwide,
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respectively [15]. Chemotherapy agents commonly used for colorectal and gastric cancer are similar which include fluorouracil, oxaliplatin and irinotecan. Oxaliplatin- and irinotecan-induced special hepatic injury had been increasingly recognized, including sinusoidal obstructive syndrome (SOS) and steatohepatitis [16, 17]. Whether these drugs can increase hepatic complications during chemotherapy in patients with HBV infection has not been reported. The objectives of this study were to investigate the incidences of HBV reactivation and hepatitis in gastrointestinal cancer patients with positive HBsAg after chemotherapy and assess the effect of antiviral therapy on preventing HBV reactivation and hepatitis.
Patients and methods Patients Medical records were reviewed from inpatient cases in Cancer Center of West China Hospital from January 2009 to August 2014. The eligibility criteria were as follows: histologically proven colonic, rectal or gastric cancer; positive HBsAg before starting chemotherapy; prechemotherapy alanine aminotransferase (ALT) and (AST) 100 IU/L when compared with the prechemotherapy baseline level [2, 11, 19]. The severity of hepatitis was divided into three stages. “Mild” was defined as an elevation in the ALT
ORIGINAL ARTICLE
Hepatitis B virus reactivation and hepatitis in gastrointestinal cancer patients after chemotherapy Yu Yang · Yang Du · Wu‑Xia Luo · Cong Li · Ye Chen · Ke Cheng · Jing Ding · Yi Zhou · Jun Ge · Xian Yang · Ji‑Yan Liu
Received: 12 December 2014 / Accepted: 6 February 2015 © Springer-Verlag Berlin Heidelberg 2015
Abstract Purpose The objectives of this study were to investigate the incidences of hepatitis B virus (HBV) reactivation and hepatitis in gastrointestinal cancer patients with positive hepatitis B surface antigen (HBsAg) after chemotherapy and assess the effect of antiviral therapy on preventing HBV reactivation and hepatitis. Methods The medical records of gastric or colorectal cancer patients with positive HBsAg undergoing chemotherapy in West China Hospital were reviewed from January 2009 to August 2014. Results One hundred and fifty-six patients were included. Seventy-six patients had no records of the baseline HBV DNA copy (bHDC) and received no antiviral therapy. Of 80 patients with known bHDCs, 39 patients received antiviral therapy. The incidence of HBV reactivation was 14.6 % in the non-antiviral group with known bHDCs (n = 41), compared with 0 % in the antiviral group (P = 0.039). Compared with 12.8 % in the antiviral group (P = 0.034), 29.9 % of patients suffered from hepatitis in the total non-antiviral group (n = 117). More patients with moderate/severe hepatitis were seen in the non-antiviral group (P = 0.027). Non-antiviral therapy was the only risk factor for hepatitis in multivariate analysis (HR 3.195, 95 % CI 1.117–10.989; P = 0.043).
Yu Yang and Yang Du have contributed equally to this work. Y. Yang · Y. Du · W.‑X. Luo · C. Li · Y. Chen · K. Cheng · J. Ding · Y. Zhou · J. Ge · X. Yang · J.‑Y. Liu (*) Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, No. 37, Guo Xue Xiang, Chengdu 610041, Sichuan Province, China e-mail: [email protected]
Conclusions HBV reactivation and hepatitis occurred in a significant proportion of gastrointestinal cancer patients with positive HBsAg who received chemotherapy. Antiviral therapy could reduce the incidences of HBV reactivation and hepatitis. Keywords HBV reactivation · Hepatitis · Antiviral therapy · Gastrointestinal cancer · Chemotherapy
Introduction Hepatitis B is a global health concern, and of all chronically infected carriers worldwide, approximately 75 % are found in the Asia–Pacific regions. Among Chinese population aged over 3 years, the prevalence of hepatitis B surface antigen (HBsAg) is 9.09 % [1]. Reactivation of hepatitis B virus (HBV) is a well-recognized complication of antitumor chemotherapy for HBV carriers in some kinds of cancer. The clinical consequences are characterized by raised levels of serum HBV DNA and hepatotoxicity varying from asymptomatic elevation of transaminase to fatal hepatic failure. HBV reactivation had mainly been focused on patients with lymphoma because the high incidence was up to 21–73 % [2–6]. The incidence of HBV reactivation was also reported to range from 21 to 46 % in patients with breast cancer [7–9]. Anthracycline and corticosteroids as parts of the chemotherapeutic combination or premedication were both usually involved in treatment of lymphoma and breast cancer. These two drugs were found to increase the risk of HBV reactivation [10–14]. To date, the data of HBV reactivation for other solid tumors were so far limited. Gastrointestinal cancer is the most common malignant tumor of digestive tract, and the incidences of colorectal and gastric cancer rank the third and fourth worldwide,
13
respectively [15]. Chemotherapy agents commonly used for colorectal and gastric cancer are similar which include fluorouracil, oxaliplatin and irinotecan. Oxaliplatin- and irinotecan-induced special hepatic injury had been increasingly recognized, including sinusoidal obstructive syndrome (SOS) and steatohepatitis [16, 17]. Whether these drugs can increase hepatic complications during chemotherapy in patients with HBV infection has not been reported. The objectives of this study were to investigate the incidences of HBV reactivation and hepatitis in gastrointestinal cancer patients with positive HBsAg after chemotherapy and assess the effect of antiviral therapy on preventing HBV reactivation and hepatitis.
Patients and methods Patients Medical records were reviewed from inpatient cases in Cancer Center of West China Hospital from January 2009 to August 2014. The eligibility criteria were as follows: histologically proven colonic, rectal or gastric cancer; positive HBsAg before starting chemotherapy; prechemotherapy alanine aminotransferase (ALT) and (AST) 100 IU/L when compared with the prechemotherapy baseline level [2, 11, 19]. The severity of hepatitis was divided into three stages. “Mild” was defined as an elevation in the ALT
