Hepatitis B reactivation risk in patients with solid tumors receiving single-agent capecitabine versus doxorubicin-based chemotherapy.

Abstract

1575 Background: Reactivation of hepatitis B virus (HBV) in cancer patients on chemotherapy is a challenge especially in Asia where HBV infection is endemic. Risk of HBV reactivation differs according to cancer type, chemotherapy regimen, and concomitant use of steroids. The United States Centre for Disease Control and Prevention recommends universal screening for chronic HBV infection for all patients before chemotherapy although screening for low-risk chemotherapy regimens may not be cost effective. Methods: We sought to assess and compare HBV reactivation risk and effectiveness of prophylactic anti-viral therapy in preventing HBV reactivation in patients receiving a ‘high-risk’ (doxorubicin-based) chemotherapy regimen for which prophylactic anti-viral therapy for hepatitis B carriers is generally accepted versus a ‘low-risk’ (single agent capecitabine) chemotherapy regimen for solid tumours at a tertiary cancer centre. The electronic medical records of eligible patients were reviewed between January 2007 and December 2010. Results: A total of 708 patients were identified, including 434 and 274 who received doxorubicin-based chemotherapy and single agent capecitabine respectively. HBV screening rate was 42.6% (51% for doxorubicin-based chemotherapy, 30% for single agent capecitabine, p<0.0001). 15/302 (5%) screened patients were found to be hepatitis B carriers (6 on doxorubicin, 9 on capecitabine). Overall, 3/708 patients (0.4%) developed HBV reactivation (all from the unscreened doxorubicin group, 3/214 (1.4%) compared to 0/192 (0%) unscreened patients in the capecitabine group, p<0.0001). All 15 identified hepatitis B carriers received prophylactic anti-viral therapy (14 received lamuvidine, 1 had entacavir) and none had HBV reactivation. Conclusions: Not all chemotherapy regimens are associated with risk of HBV reactivation. Routine hepatitis B screening and prophylaxis for low-risk chemotherapy regimens such as single agent capecitabine may add morbidity and may not be cost effective.