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Annals of Oncology 2004 15(11):1661-1666; doi:10.1093/annonc/mdh430
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© 2004 European Society for Medical Oncology

Original Article

Hepatitis B reactivation in patients with hepatocellular carcinoma undergoing systemic chemotherapy

W. Yeo1,*, K. C. Lam1, B. Zee1, P. S. K. Chan1,2, F. K. F. Mo1, W. M. Ho1, W. L. Wong1, T. W. T. Leung1, A. T. C. Chan1, B. Ma1, T. S. K. Mok1 and P. J. Johnson1

Departments of 1 Clinical Oncology and 2 Microbiology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong

* Correspondence to: Dr. W. Yeo, Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong. Tel: +852-2632-2118; Fax: +852-2649-7426; Email: winnieyeo{at}cuhk.edu.hk

Background: Cancer patients who are hepatitis B virus (HBV) carriers and undergoing chemotherapy (CT) may be complicated by HBV reactivation. Over 80% of hepatocellular carcinoma (HCC) patients are HBV carriers; however, the incidence of HBV reactivation during CT has not been well-reported. A prospective study was conducted to determine the incidence of HBV reactivation, the associated morbidity and mortality, and possible risk factors.

Patients and methods: 102 HBsAg-positive patients with inoperable HCC underwent systemic CT. Patients received either combination cisplatin, interferon, doxorubicin and fluorouracil (PIAF) or single-agent doxorubicin. They were followed up during and for 8 weeks after CT.

Results: In 102 patients, 59 (58%) developed hepatitis amongst whom 37 (36%) were attributable to HBV reactivation. Twelve (30%) died of HBV reactivation. CT was interrupted in 32 patients (86%) with reactivation and 54 (83%) without reactivation (P>0.05). The median survivals were 6.00 and 5.62 months, respectively (P=0.694). Elevated baseline alanine aminotransferase (ALT) was found to be a risk factor.

Conclusion: HBV reactivation is a common cause of liver damage during CT in HBsAg-positive HCC patients. The only identifiable associated risk factor was elevated pre-treatment ALT. Further studies into the role of antiviral and novel anticancer therapies are required to improve the prognosis of these patients.

Key words: chemotherapy, HBsAg, liver cancer, viral reactivation


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