Hepatitis B virus (HBV) reactivation may complicate cytotoxic chemotherapy used in the treatment of breast cancer, according to a report in the August Journal of Medical Virology.
HBV reactivation is a well-recognized phenomenon in patients treated for hematological malignancies, the authors explain, but limited information about HBV reactivation is available for patients with breast cancer.Dr. Winnie Yeo and colleagues from Chinese University of Hong Kong followed 41 breast cancer patients found to be HBsAg-positive at baseline through their course of chemotherapy for HBV reactivation using conventional monitoring and serial HBV DNA monitoring.Ten of the 41 patients (24%) developed clinical HBV reactivation during cytotoxic chemotherapy for breast cancer, the authors report. Seven more patients were diagnosed by the detection of HBV DNA.All 17 patients with HBV reactivation had normalization of function after treatment with lamivudine. No patient died as a result of HBV reactivation.HBV reactivation prompted premature termination of chemotherapy in 6 women and a delay of at least 1 week in completing chemotherapy in 6 other women. “Thus, the researchers note, “overall 12 of the 17 patients (71%) who developed HBV reactivation, as compared with 8 of the 24 patients (33%) who did not develop the condition, suffered premature discontinuation/delay of chemotherapy.”No risk factors could be identified to distinguish women who developed HBV reactivation from those who did not develop HBV reactivation.”In a common disease such as breast cancer, in which combination chemotherapy is an important modality of therapy,” the authors conclude, “HBV reactivation constitutes a major cause of chemotherapy-related hepatic morbidity in HBsAg-seropositive subjects.””Regular monitoring with HBV DNA in addition to ALT during the immunosuppressed period may enable early detection of the condition and facilitate prompt antiviral therapy when a predetermined threshold of HBV DNA is reached, prior to hepatic inflammation and destruction,” the investigators write.”Alternatively,” where HBV DNA assays are not available, “the prophylactic use of an antiviral drug in all patients before and throughout chemotherapy is being considered.”J Med Virol 2003;70:553-561.