Tang, W., Chen, L., Zheng, R., Pan, L., Gao, J., Ye, X., . . . Zheng, W. (2015). Prophylactic effect of lamivudine for chemotherapy-induced hepatitis B reactivation in breast cancer: A meta-analysis. PLOS One, 10, e0128673.
STUDY PURPOSE: To determine the effect of prophylactic or preemptive treatment with lamivudine for patients with breast cancer who were hepatitis B surface antigen positive on the following: (a) the rate of hepatitis B virus (HBV) reactivation, which was defined as an increase in HBV DNA levels more than 10 times or an absolute increase of HBV DNA levels that exceeded 1×109 copies/ml; (b) incidence of hepatitis, which was defined as greater than a three times increase in alanine aminotransferase (ALT) that exceeded the upper limit of normal range (ULN) or an absolute increase of ALT of more than 100 u/l; (c) rate of chemotherapy disruption, which was defined as either a premature termination of chemotherapy or a delay of more than eighty days of chemotherapy between cycles; and (d) overall mortality. Secondary outcomes included incidence of HBV-related hepatitis, rate of HBV-related chemotherapy disruption, HBV-related mortality, occurrence of YMDD mutations, and withdrawal hepatitis.
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Elder care
An early preemptive strategy is superior to a therapeutic strategy in decreasing the incidence of HBV reactivation, HBV-related hepatitis, and the rate of chemotherapy disruption in patients with breast cancer.
In this study, 16% of patients who were HBsAg positive undergoing chemotherapy for breast cancer developed overt hepatitis. Using a preemptive strategy of prescribing lamivudine at the commencement of chemotherapy decreased the rate of hepatitis to 2.2%. The authors noted that, as level III evidence, the AASLD (American Association for the Study of Liver Diseases) recommends that HBV carriers receiving cancer chemotherapy or immunosuppressive therapy with a baseline HBV DNA of less than 2,000 iu/ml should start antiviral therapy at the commencement of treatment and continue it for six months after the completion of chemotherapy or immunosuppressive therapy.