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Preventing chemotherapy-induced hepatitis B reactivation in breast cancer patients: a prospective comparison of prophylactic versus deferred preemptive lamivudine

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Abstract

Purpose

Prophylactic lamivudine to prevent chemotherapy-induced hepatitis B virus (HBV) reactivation has been widely adopted in hematological cancer patients. We examined the deferred preemptive strategy, upon rising viremia, in breast cancer (BC) patients based on sensitive serum HBV DNA level monitoring in a non-randomized controlled study.

Patients and methods

Baseline virological profiles before cytotoxic chemotherapy were retrospectively analyzed in historical BC and non-BC patients. A prospective cohort study, including 22 early BC patients (Group I) who were hepatitis B surface antigen (HBsAg)± and required adjuvant chemotherapy, were enrolled and had deferred preemptive use of lamivudine upon viremic surge. During the study period, another 23 BC patients, who did not participate in the abovementioned study, received prophylactic use of lamivudine as routine practice (Group 2). Chemotherapy-induced hepatitis events and the lamivudine treatment course were compared.

Results

There was no significant difference in the incidence of hepatitis during chemotherapy between these two groups. Patients in Group I had statistically significant shorter duration of lamivudine use during chemotherapy. However, once lamivudine had been initiated, the treatment course is not significantly shorter than those patients given prophylactically.

Conclusions

Deferred preemptive strategy is feasible to control HBV replication and prevent its reactivation in BC patients undergoing chemotherapy. However, it may not be superior to prophylactic strategy and clinically practical.

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Acknowledgement

This work is supported in part by the research grants from Taiwan Tri-Service General Hospital (TSGH-C92-08 and TSGH-C93-14) and Taiwan National Science Council (NSC93-2314-B-016-017).

Authors' disclosures of potential conflicts of interest

The authors indicated no potential conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Tri-Service General Hospital, Taipei, Taiwan

    Shih-Hung Tsai

  2. Division of Hematology/Oncology, Tri-Service General Hospital, Taipei, Taiwan

    Ming-Shen Dai, Ching-Liang Ho, Yeu-Chin Chen, Yi-Ying Wu, Ping-Ying Chang & Woei-Yau Kao

  3. Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan

    Jyh-Cherng Yu

  4. Division of Hematology/Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

    Tsu-Yi Chao

  5. National Cancer Institute, National Health Research Institutes, Taipei, Taiwan

    Tsu-Yi Chao

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  1. Shih-Hung Tsai
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  2. Ming-Shen Dai
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  3. Jyh-Cherng Yu
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  8. Woei-Yau Kao
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  9. Tsu-Yi Chao
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Corresponding author

Correspondence to Tsu-Yi Chao.

Additional information

Shih-Hung Tsai and Ming-Shen Dai contributed equally to this work.

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Tsai, SH., Dai, MS., Yu, JC. et al. Preventing chemotherapy-induced hepatitis B reactivation in breast cancer patients: a prospective comparison of prophylactic versus deferred preemptive lamivudine. Support Care Cancer 19, 1779–1787 (2011). https://doi.org/10.1007/s00520-010-1019-2

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  • DOI: https://doi.org/10.1007/s00520-010-1019-2

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