title: Hepatitis B virus reactivation in breast cancer patients undergoing chemotherapy: A review and meta-analysis of prophylaxis management.
abstract: Hepatitis B virus (HBV) reactivation during or after chemotherapy in patients with breast cancer has become a remarkable clinical problem. Prophylactic nucleos(t)ide analogues (NAs) are recommended for patients with breast cancer who are hepatitis B surface antigen (HBsAg) positive before chemotherapy. We performed an up-to-date meta-analysis to compare the efficacy of prophylactic lamivudine use with nonprophylaxis in HBsAg-positive breast cancer patients undergoing chemotherapy. PubMed, the Cochrane Library and China National Knowledge Infrastructure (CNKI) databases were searched for relevant articles until June 2016. Eligible articles comparing the efficacy of prophylactic lamivudine use with nonprophylaxis in HBsAg-positive breast cancer patients undergoing chemotherapy were identified. Eight studies which had enrolled 709 HBsAg-positive breast cancer patients undergoing chemotherapy were analysed. Lamivudine prophylaxis significantly reduced the rates of chemotherapy-associated hepatitis B flares in chronic hepatitis B in breast cancer compared with patients with nonprophylaxis (odds ratio [OR]=0.15, 95% confidence interval [CI]: 0.07-0.35, P<.00001). Chemotherapy disruption rates attributed to HBV reactivation in the prophylaxis groups were significantly lower than the nonprophylaxis groups (OR=0.17, 95% CI: 0.07-0.43, P=.0002). Patients with lamivudine prophylaxis had a higher risk for tyrosine-methionine-aspartate-aspartate (YMDD) motif mutations than patients with nonprophylaxis (OR=6.33, 95% CI: 1.01-39.60, P=.05). Prophylactic antiviral therapy management is necessary for HBsAg-positive breast cancer patients undergoing chemotherapy, in spite of high correlation with lamivudine-resistant HBV variants with YMDD motif mutations.
authors.affiliation: Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetic and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of oncology Surgery, The First Hospital of Lanzhou University, Lanzhou, China.
authors.forename: L
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetic and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: G
authors.initials: G
authors.lastname: Liang
authors.affiliation: Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetic and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: E
authors.initials: E
authors.lastname: Song
authors.affiliation: Cardiff China Medical Research Collaborative, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: W
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.|Division of Medicine, Liver Failure Group ILDH, UCL Medical School, London, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetic and Gene Regulation, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.|Cardiff China Medical Research Collaborative, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: C
authors.initials: C
authors.lastname: Gong
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy*; D018890:Chemoprevention / Q000379:methods; D002681:China / Q000453:epidemiology; D004358:Drug Therapy / Q000379:methods*; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage; D016896:Treatment Outcome; D014775:Virus Activation
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D019259:Lamivudine
keywords: breast cancer; hepatitis B; lamivudine; prophylaxis antiviral therapy; reactivation