Onkológia 6/2011

Hepatitis B in the cancer patients treated by chemotherapy

Hepatitis B could be reactivated during or after cessation of chemo- and immunosupresive therapy in the cancer patients. Reactivaton of HBV infection could lead to asymptomatic or symptomatic hepatitis B, to liver failure or to death related to HBV reactivation. Risk factors associated with HBV reactivation include high HBV DNA levels, HBe antigen positivity, male gender, heamatological malignancies and treatment with corticosteroids or rituximab. Prophylactic therapy by nucleot(s)ide analogues reduces hepatitis B flares incidence. Clinical trials have demonstrated that prophylactic antiviral therapy by nucleot(s)ide analogues is superior to deffered treatment in the cancer patients. Nucleot(s)ide analogues with low barrier to resistance (lamivudine) can be used if the anticipated duration of the cancer treatment is short (≤ 12 months) and baseline HBV DNA is not detectable. Nucleot(s)ide analogues with high barrier to resistance (entecavir, tenofovir) can be used if the anticipated duration of the cancer treatment is longer than 12 months. It is recommended to continue prophylactic therapy with nucleot(s)ide analogues after withdrawal of chemo- and immunosupresive therapy. EASL, AASLD and ASCO guidelines for management of chronic hepatitis B in the cancer patients are presented in this paper.

Keywords: hepatitis B reactivation, cancer patients, nucleot(s)ide analogues, lamivudine, tenofovir, entecavir.