Prevention of hepatitis B virus reactivation in patients with nasopharyngeal carcinoma with lamivudine.
OBJECTIVE
Although the mainstay of treatment of patients with nasopharyngeal carcinoma (NPC) had been radiotherapy, chemotherapy has increasingly been adopted in conjunction with radiation and in advanced disease. In parts of Asia where NPC is prevalent, it is also known that around 10% of the population has chronic hepatitis B virus (HBV) infection. Cancer patients who are HBV carriers are frequently complicated by HBV reactivation during chemotherapy. This may result in liver damage, which disrupts anticancer therapy and compromises the patients' prognosis. In its most severe form, fatal hepatic failure may occur. With the increasing use of chemotherapy in NPC, the occurrence of HBV reactivation is likely to increase further. Although recent reports have suggested that the antiviral agent lamivudine may reduce HBV reactivation and its associated morbidity, there has been no data on this aspect in NPC patients. This study assessed the role of lamivudine in preventing HBV reactivation and its associated morbidity in NPC patients who have chronic HBV infection and are undergoing chemotherapy.


METHODS
Two groups were studied. One group consisted of 16 patients who received prophylactic lamivudine prior to and until 8 weeks after discontinuing chemotherapy. The other comprised 21 historical control subjects who underwent chemotherapy without prophylactic lamivudine. The outcomes were compared.


RESULTS
With prophylactic lamivudine, there were significantly fewer incidences of hepatitis (6.7% vs 33.3%, P = 0.047) and HBV reactivation (0% vs 28.6%, P = 0.027), and less disruption of chemotherapy (18.8% vs 67.7%, P = 0.045).


CONCLUSIONS
Prophylactic lamivudine significantly reduces the incidence and morbidity of HBV reactivation in NPC patients undergoing chemotherapy.
Yeo
Winnie
W
Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. winnieyeo@cuhk.edu.hk
Hui
Edwin P
EP
Chan
Anthony T C
AT
Ho
Wing M
WM
Lam
Kwok C
KC
Chan
Paul K S
PK
Mok
Tony S K
TS
Lee
Jam J
JJ
Mo
Frankie K F
FK
Johnson
Philip J
PJ
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D000998:Antiviral Agents / Q000494:pharmacology*; D002353:Carrier State / Q000517:prevention & control; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006515:Hepatitis B virus / Q000187:drug effects* / Q000302:isolation & purification / Q000502:physiology; D006801:Humans; D015994:Incidence; D019259:Lamivudine / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D014775:Virus Activation / Q000187:drug effects*
D000998:Antiviral Agents; D019259:Lamivudine; D002945:Cisplatin