Hepatitis B Virus Reactivation and Prophylaxis During Solid Tumor Chemotherapy

Background: Solid tumor chemotherapy regimens pose a riskfor hepatitis B virus (HBV) reactivation, but screening and antiviralprophylaxis remains controversial because of insufficientevidence.Purpose: To determine the risk for HBV reactivation with andwithout antiviral prophylaxis and the effectiveness of prophylaxisin adults with solid tumors and chronic or resolved HBV infection.Data Sources: MEDLINE through 1 July 2015 and Web of Science,Cochrane Central Register of Controlled Trials, TOXNET,and Scopus through 1 March 2015.Study Selection: 26 English-language observational studiesand randomized, controlled trials in patients with chronic or resolvedHBV receiving chemotherapy for solid tumors.Data Extraction: Study characteristics, quality, and risk of biaswere assessed by 1 researcher and verified by another independentresearcher.Data Synthesis: Random-effects model meta-analyses wereused to estimate the risk and odds ratio (OR) of reactivation withversus without antiviral prophylaxis. Reactivation in chronic HBVwithout prophylaxis ranged from 4% to 68% (median, 25%) withsubstantial heterogeneity. Prophylaxis reduced the risk for HBVreactivation (OR, 0.12 [95% Cl, 0.06 to 0.22]), HBV-related hepatitis(OR, 0.18 [Cl, 0.10 to 0.32]), and chemotherapy interruption(OR, 0.10 [Cl, 0.04 to 0.27]). In 3 studies of patients with resolvedHBV infection, none received HBV prophylaxis and reactivationrisk ranged from 0.3% to 9.0%.Limitations: Significant heterogeneity in underlying study populationsand treatment regimens, incomplete baseline data, possibilityof publication bias, and limited study quality. Most studieswere observational and from Asia.Conclusion: In patients with chronic HBV receiving solid tumorchemotherapy, the risk for HBV reactivation is similar to the riskwith other types of immunosuppressive therapy. Results supportHBV screening and antiviral prophylaxis before initiation of chemotherapyfor solid tumors.Primary Funding Source: National Center for AdvancingTranslational Sciences and National Institutes of Health