title: Use of entecavir to prevent hepatitis B virus reactivation during cytotoxic chemotherapy for solid malignancy.
abstract: Reactivation of hepatitis B virus (HBV) infection is a frequent complication of cytotoxic chemotherapy that includes steroids. International studies have shown that lamivudine reduces the incidence and severity of hepatitis in HBV carriers undergoing chemotherapy to treat malignancies. However, prolonged lamivudine therapy is associated with an increased risk of drug-resistant tyrosine-methionine-aspartate-aspartate (YMDD) mutations. Here, we studied the role of entecavir in preventing morbidity and mortality associated with HBV reactivation. Three patients with both solid malignancies and hepatitis B surface antigen-positive hepatitis B underwent cytotoxic chemotherapy with steroids. They were followed up for at least 6 months after the completion of chemotherapy. The chemotherapeutic regimens comprised carboplatin and paclitaxel for non-small-cell lung cancer, and docetaxel monotherapy or cyclophosphamide plus epirubicin for breast cancer, respectively. All patients completed chemotherapy with steroids without developing severe hepatitis that could be attributable to HBV reactivation. Entecavir prevented the incidence and severity of hepatitis in HBV carriers undergoing chemotherapy for malignancies. Although further studies are required to evaluate whether entecavir can prevent the increased risk of YMDD mutation and decrease the rates of disrupted chemotherapy due to severe hepatitis more effectively than lamivudine, entecavir should be considered before lamivudine for such patients.
authors.affiliation: Department of Clinical Oncology, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553, Japan. rokita@hiroshima-u.ac.jp.|Department of Surgical Oncology, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553, Japan. rokita@hiroshima-u.ac.jp.
authors.forename: Riki
authors.initials: R
authors.lastname: Okita
authors.affiliation: Department of Clinical Oncology, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553, Japan.|Department of Breast Surgery, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Department of Clinical Oncology, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Narahara
authors.affiliation: Department of Surgical Oncology, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sanada
authors.affiliation: Department of Surgical Oncology, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553, Japan.
authors.forename: Morihito
authors.initials: M
authors.lastname: Okada
authors.affiliation: Department of Medicine and Molecular Science, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553, Japan.
authors.forename: Yoshiiku
authors.initials: Y
authors.lastname: Kawakami
authors.affiliation: Department of Medicine and Molecular Science, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
authors.affiliation: Department of Gastroenterology, Shimonoseki Kosei Hospital, Kamishinchi-cho 3-3-8, Shimonoseki, Yamaguchi, 750-0061, Japan.
authors.forename: Kiwamu
authors.initials: K
authors.lastname: Okita
keywords: Chemotherapy; Entecavir; Hepatitis B virus; Solid malignancy; Steroid