title: Hepatitis B reactivation in patients with hepatocellular carcinoma undergoing systemic chemotherapy.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong. winnieyeo@cuhk.edu.hk
authors.forename: W
authors.initials: W
authors.lastname: Yeo
authors.forename: K C
authors.initials: KC
authors.lastname: Lam
authors.forename: B
authors.initials: B
authors.lastname: Zee
authors.forename: P S K
authors.initials: PS
authors.lastname: Chan
authors.forename: F K F
authors.initials: FK
authors.lastname: Mo
authors.forename: W M
authors.initials: WM
authors.lastname: Ho
authors.forename: W L
authors.initials: WL
authors.lastname: Wong
authors.forename: T W T
authors.initials: TW
authors.lastname: Leung
authors.forename: A T C
authors.initials: AT
authors.lastname: Chan
authors.forename: B
authors.initials: B
authors.lastname: Ma
authors.forename: T S K
authors.initials: TS
authors.lastname: Mok
authors.forename: P J
authors.initials: PJ
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D004279:DNA, Viral / Q000032:analysis / Q000378:metabolism; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006509:Hepatitis B / Q000209:etiology* / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D007124:Immunoenzyme Techniques; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000009:adverse effects; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011994:Recombinant Proteins; D012307:Risk Factors
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D004317:Doxorubicin; D000410:Alanine Transaminase; D002945:Cisplatin; D005472:Fluorouracil