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Published in: Supportive Care in Cancer 11/2012

01-11-2012 | Review Article

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

Authors: Jessica P. Hwang, John M. Vierling, Andrew D. Zelenetz, Susan C. Lackey, Rohit Loomba

Published in: Supportive Care in Cancer | Issue 11/2012

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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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Metadata
Title
Hepatitis B virus management to prevent reactivation after chemotherapy: a review
Authors
Jessica P. Hwang
John M. Vierling
Andrew D. Zelenetz
Susan C. Lackey
Rohit Loomba
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 11/2012
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-012-1576-7

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Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine