Hepatitis B Reactivation: A Potentially Serious Complication of Chemotherapy for Solid Tumors
Received Date: January 02, 2019; Published Date: January 22, 2020
We present a case of hepatitis B reactivation in a patient receiving adjuvant chemotherapy for early breast cancer. This is a 49-year-old post-menopausal, Chinese female with history of chronic hepatitis B with inactive carrier state, and right invasive ductal carcinoma staged as cT2N1M0, pT2N1aM0, anatomic stage IIB, prognostic stage IIA, estrogen and progesterone receptor positive, and human epidermal growth factor 2 negative. The patient underwent bilateral mastectomy with implant reconstruction and right axillary lymph node dissection followed by adjuvant chemotherapy planned as dose dense doxorubicin and cyclophosphamide (ddAC), followed by dose dense paclitaxel (ddT). Two weeks after her first cycle of dose dense paclitaxel, she developed grade III HBV reactivation with hepatitis. This report highlights HBV reactivation as a potential complication of chemotherapy for solid tumors, and reviews recommended HBV screening, prevention and management of HBV reactivation in this patient population.
Keywords: Hepatitis b virus; Reactivation; Hepatitis; Solid tumors; Cancer; Chemotherapy; Antiviral; Prophylaxis; Screening; Breast cancer
Abbreviations: AALD - American Association for the Study of Liver Disease; AGA - American Gastroenterological Association Institute; ALT - alanine transferase; ASCO - American Society of Clinical Oncology; AST - aspartate aminotransferase; CDC - US Centers for Disease Control and Prevention; ddAC – Dose dense Doxorubicin Cyclophosphamide; ddT – Dose Dense Paclitaxel; ER – Estrogen Receptor; ESMO - European Society for Medical Oncology; FISH - Fluorescence in situ hybridization; HBV - Hepatitis B Virus; HBcAb – Hepatitis B Core antibody; HBeAg – Hepatitis B e antigen; HBsAb – Hepatitis B surface antibody; HBsAg – Hepatitis B surface antigen; HBV DNA – Hepatitis B Virus Deoxyribonucleic Acid; HCC - hepatocellular carcinoma; HER2 – human epidermal growth factor receptor 2; INR - International normalized ratio; NCCN - National Comprehensive Cancer Network; PR–Progesterone Receptor; TACE–transarterial chemoembolization; TNF-α - Tumor Necrosis Factor-alpha