title: Glioblastoma multiforme and hepatitis B: do the right thing(s).
abstract: OBJECTIVE
  Hepatitis B virus (HBV) reactivation is a well-known complication related to immunosuppression. Clinical manifestations of HBV relapse range from self-limiting anicteric hepatitis to acute hepatic failure. Temozolomide (TMZ) is an alkylating agent used for the treatment of glioblastoma multiforme (GBM), the most common and deadliest of malignant primary brain tumors.
  
  
  METHODS
  We report the case of a 52-year old man with a history of serological positivity for hepatitis B surface antigen (HBsAg) who was diagnosed with GBM. Since the tumor was multifocal and thus inoperable, the patient received radiotherapy with concomitant TMZ and corticosteroids, without a prophylactic therapy for HBV infection. Acute hepatitis developed five months later the beginning of anticancer therapy. We started antiviral entecavir, which led to a decrease of HBV-DNA titer to 20 IU/ml, allowing the prosecution of the TMZ therapy.
  
  
  CONCLUSIONS
  Up to now only four other cases of HBV relapse during TMZ therapy have been reported in literature. These cases underline the need of HBV screening and antiviral prophylaxis before starting TMZ administration.
authors.affiliation: Department of Digestive and Liver Disease, School of Medicine and Psychology, Sapienza University, Azienda Ospedaliera S. Andrea, Rome, Italy. flaminia.purchiaroni@hotmail.it.
authors.forename: F
authors.initials: F
authors.lastname: Purchiaroni
authors.forename: P
authors.initials: P
authors.lastname: Begini
authors.forename: G
authors.initials: G
authors.lastname: Minniti
authors.forename: S
authors.initials: S
authors.lastname: Gallina
authors.forename: G
authors.initials: G
authors.lastname: Delle Fave
authors.forename: M
authors.initials: M
authors.lastname: Marignani
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D003606:Dacarbazine / Q000009:adverse effects / Q000031:analogs & derivatives*; D005909:Glioblastoma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006509:Hepatitis B / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D006515:Hepatitis B virus / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077204:Temozolomide; D014775:Virus Activation / Q000187:drug effects
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide