Preventive
Treatment for Hepatitis B Helps Avoid Relapse during Chemotherapy for Cancer
Anti-HBV
treatment helps to prevent relapse (recurrence) of hepatitis
B in patients who have cancer
and who are on chemotherapy, according to the results of a new study. The study
results appear in the February 2006 issue of Hepatology,
the official journal of the American Association for the Study of Liver Diseases
(AASLD). Hepatology is available online via Wiley
InterScience.
Patients who develop hepatocellular carcinoma (HCC), a type of liver cancer caused
by the hepatitis B virus, have up to a 55 percent chance of having the virus reactivated
during chemotherapy. The idea of preemptively treating these patients with the
antiviral drug lamivudine (3TC; Epivir-HBV)
in order to prevent hepatitis B relapse and it varying complications is promising
but has never been investigated in patients with HCC.
Researchers led
by Jeong Won Jang of the Department of Internal Medicine
at the Catholic University of Korea in Seoul, conducted a prospective, randomized study
on pre-treating HCC patients undergoing chemotherapy with lamivudine between January 2004 and February 2005. The
study involved 36 patients with HCC who were given the drug while undergoing transarterial
chemo-lipiodolization (TACL) chemotherapy and a control
group of 37 patients who underwent the chemotherapy without receiving lamivudine. The chemotherapy was continued every month without
any limit on the number of cycles until the tumors disappeared, while treatment
with lamivudine began with the chemotherapy and continued
for 12 months following its completion.
In total, 43 percent of the patients in the control group developed overall clinical
hepatitis during the follow-up period, compared to 17 percent of the patients
who took lamivudine. In addition, there was a significantly
higher incidence of severe hepatitis in the control group and the researchers
established the level of viral load (>104 copies/ml) that predicted whether
a patient would have a relapse of hepatitis B.
In addition to demonstrating
that treatment with lamivudine significantly reduced
hepatitis B reactivation, allowing chemotherapy to continue in these cancer patients,
the study suggests that lamivudine therapy decreases
the severity of clinical hepatitis if it develops during chemotherapy. “The beneficial
effects of preemptive therapy on the severity of hepatitis most probably result
from an elimination of any potential risk arising from viral reactivation,” the
authors state.
While previous studies have shown a higher hepatitis
B viral load (HBV DNA) as a predictor of hepatitis B reactivation,
the lower cutoff in the current study was identified as a better predictor and
the authors urge the use of a highly sensitive test to detect and measure HBV
viral load in order to identify patients at the greatest risk of hepatitis B reactivation.
In
those patients with lower viral loads, it would still be beneficial to closely
monitor virological and biochemical changes when they are undergoing
repeated courses of chemotherapy, since the study demonstrated that even lower
viral loads are associated with an approximately 30 percent risk of viral reactivation.
Although the study did not examine long-term
survival in the patients who took lamivudine,
the authors conclude: “Given that preemptive antiviral therapy ameliorates the
hepatic morbidity
seen during transarterial chemotherapy and facilitates
further chemotherapy without disruptions in the treatment schedules, the expectation
would be for an increased chance of survival with this approach.” 02/03/06 Reference
J W Jang. A Randomized Controlled
Study of Preemptive Lamivudine in Patients Receiving
Transarterial Chemo-Lipiodolization.
Hepatology 43(2): 233-240. February 2006. http://www.interscience.wiley.com/journal/hepatology | 
