Reactivation of hepatitis B virus after glioblastoma treatment with temozolomide--case report.
A 61-year-old man with glioblastoma and positive for hepatitis B surface antigen (HBsAg) developed acute hepatitis due to hepatitis B virus (HBV) reactivation after concomitant postoperative treatment with temozolomide (75 mg/m(2)/day) and radiation therapy (60 Gy in 30 fractions). Corticosteroids were not used during chemo-radiation therapy, and grade 4 lymphocytopenia was observed. The levels of liver function tests (LFTs), including levels of aspartate aminotransferase and alanine aminotransferase, increased 5 weeks after the completion of chemo-radiation therapy, and reached the maximum levels of 1,549 IU/l (normal 13 to 33 IU/l) and 1,653 IU/l (normal 8 to 42 IU/l), respectively, after 2 weeks. At this point, serum HBV-deoxyribonucleic acid (DNA) level had increased to 630-fold over the baseline, and therapy with the antivirus agent entecavir (0.5 mg daily) was started. Over the next 2 weeks, the levels of LFTs and HBV-DNA improved. The present and previous cases suggest that grade 3/4 lymphocytopenia or grade 2 lymphocytopenia with corticosteroid use might have a significant effect on HBV reactivation. To avoid this complication, HBsAg-positive patients with glioblastoma should consult a hepatologist for initiating antivirus therapy before temozolomide treatment.
Neurosurgery and Neuro-Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan. mohno@ncc.go.jp
Makoto
M
Ohno
Yoshitaka
Y
Narita
Yasuji
Y
Miyakita
Hideki
H
Ueno
Takamasa
T
Kayama
Soichiro
S
Shibui
D000208:Acute Disease; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D001932:Brain Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000821:virology*; D003606:Dacarbazine / Q000009:adverse effects / Q000031:analogs & derivatives*; D017809:Fatal Outcome; D005909:Glioblastoma / Q000188:drug therapy / Q000601:surgery / Q000821:virology*; D006509:Hepatitis B / Q000139:chemically induced / Q000601:surgery / Q000821:virology*; D006515:Hepatitis B virus / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077204:Temozolomide; D014775:Virus Activation / Q000502:physiology*
D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide