HBV Advocate Blog: Research Shows Importance of HBV Screening Before Chemotherapy Begins

New research shows the critical need to screen cancer patients for hepatitis B before they receive immune-suppressing chemotherapy drugs.

Without preventive antiviral treatment to keep HBV replication in check, these patients risk life-threatening hepatitis B reactivation when treated with chemotherapy if they do not test positive for the hepatitis B surface antibody.

Researchers, writing in the journalHepatogastroenterology, found that HBV reactivation occurred in 3.3% of patients in one study who were treated for lymphoma (blood cancers). Two of these patients died from liver failure following the chemotherapy-induced HBV flare. (1)

Even brain cancer drugs causes hepatitis B reactivation: A fifth case of hepatitis B reactivation was reported in a brain cancer patient treated with radiation and the chemotherapy drug called temozolomide.

Temozolomide, when combined with radiation, slows the growth of cancer cells. In this report from Rome, a man who appeared to have a resolved HBV infection was treated with chemotherapy, radiation and steroids for glioblastoma multiforme, a common and deadly brain tumor.

Doctors did not administer antivirals to counter any resurgence in HBV infection when they treated the brain cancer. In this case, within five months the patient began having symptoms of acute hepatitis B as the virus rebounded. The patient's immune system, weakened by temozolomide, could no longer keep the viral infection in check.

Doctors immediately started the 52-year-old male on the highly effective antiviral entecavir (Baraclude).

As soon as his viral load had dropped to nearly undetectable, doctor restarted the radiation and chemotherapy to treat his brain cancer.

"Up to now, only four other cases of HBV relapse during temozolomide therapy have been reported in literature," researchers wrote in the December 2014 edition of theEuropean Review for Medical and Pharmacological Sciences. "These cases underline the need of HBV screening and antiviral prophylaxis before starting temozolomide (treatment) administration."(2)

All chemotherapy patients should be screened for HBV: An unrelated article in the November issue ofHepatology also concluded that all patients receiving chemotherapy, immunotherapy, hematopoietic stem cell transplantation, or solid organ transplantation should be screened for hepatitis B and that preventive antiviral treatment be used when infection is discovered.

This screening is important given that an estimated 70% of people with hepatitis B are unaware of their infections.

"There is good evidence to support routine screening of all patients for hepatitis B prior to undergoing chemotherapy or immunosuppressive treatment," the researchers write. "Use of prompt antiviral treatment appears to diminish the risk of severe or fatal reactivation of hepatitis B." (3)

A recent report published in the Journal of the American Medical Association found also found entecavir to be highly effective in keeping HBV in check in patients treated for cancer.

The Chinese researchers who authored the report followed 121 HBV-positive patients treated with one of these chemotherapy drugs: rituximab, cyclophosphamide, doxorubicin, vincristine and/or prednisone. They reported that entecavir was more effective than lamivudine (Epivir-HBV) to prevent HBV reactivation while causing fewer side effects(4).