Acute exacerbation of hepatitis C in hepatocellular carcinoma patients receiving chemotherapy.
Acute hepatitis C exacerbations can occur in cancer patients carrying hepatitis C virus (HCV) when receiving systemic chemotherapy. However, clinical studies evaluating these complications remain rare due to the lack of clinically proven effective and tolerable anti-HCV treatments at late cancer stages. Furthermore, no data were available regarding hepatitis C exacerbation in advanced hepatocellular carcinoma (HCC) patients receiving chemotherapy. To address this issue, 48 patients with HCV-related advanced HCC, who underwent systemic chemotherapy using 5- fluorouracil, cisplatin, and mitoxantrone from 2008 to 2014 were analyzed. Nine patients developed acute hepatitis exacerbations defined by HCV-RNA elevation ≥10-fold and alanine transaminase (ALT) elevation ≥5-fold of the upper normal limit. Six were genotype 1b and 3 were genotype 2. Three patterns of clinical courses were observed including single episode of exacerbation (n = 5), fluctuated flares (n = 3), and delayed exacerbation (n = 1). Hepatic failure developed in five patients. Patients with acute exacerbations were less likely to have pretreatment ascites (11.1% vs. 53.8%; P = 0.028) and displayed a lower baseline ALT (44.1 ± 28.5 U/L vs. 72.6 ± 19.2 U/L; P = 0.007). Paradoxically, despite a high risk of hepatic failure, occurrence of hepatitis C exacerbation was associated with a favorable overall survival (P = 0.027; 22.8 vs. 5.4 months). In conclusion, hepatitis C exacerbation can occur in HCC patients receiving chemotherapy, leading to liver failure. However, the flare was associated with a better overall survival, possibly due to its association with a better baseline liver function. J. Med. Virol. 89:153-160, 2017. © 2016 Wiley Periodicals, Inc.
Liver Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
Ji-Wei
JW
Lin
Liver Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
Ming-Ling
ML
Chang
Liver Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
Chao-Wei
CW
Hsu
Liver Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
Yi-Cheng
YC
Chen
Liver Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
Kung-Hao
KH
Liang
Liver Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
Ya-Hui
YH
Huang
Liver Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan.
Chen-Chun
CC
Lin
Liver Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan. chautingy@gmail.com.|Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan. chautingy@gmail.com.
Chau-Ting
CT
Yeh
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000188:drug therapy*; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D004358:Drug Therapy / Q000379:methods; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000627:therapeutic use; D006526:Hepatitis C / Q000150:complications* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis
D000970:Antineoplastic Agents; D008942:Mitoxantrone; D002945:Cisplatin; D005472:Fluorouracil
5-fluorouracil; cisplatin; hepatic failure; mitoxantrone; survival