Abstract
PurposeHepatitis B virus reactivation (HBVr) in patients with gastrointestinal stromal tumors (GISTs) have not been sufficiently characterized. This study aimed to review the possible mechanism of HBVr induced by imatinib and explore appropriate measures for patient management and monitoring.MethodsThe clinical data of GIST patients who experienced HBVr due to treatment with imatinib at Xiangya Hospital (Changsha, Hunan, China) were retrospectively analyzed. A literature review was also conducted.ResultsFive cases were analyzed, including 3 cases in this study. The average age of the patients was 61.8 y, with male preponderance (4 of 5 vs. 1 of 5). These patients received imatinib as adjuvant treatment (n=4) or as neoadjuvant treatment (n=1). Primary tumors were mostly located in the stomach (n=4) or rectum (n=1). High (n=3) or intermediate (n=1) recurrence risk was categorized using the postoperative pathological results (n=4). Imatinib was then started at 400 (n=4) or 200 mg (n=1) daily. Patients first reported abnormal liver function during the 2th (n=1),6th (n=3), or 10th (n=1) month of treatment with imatinib. Some patients (n=4) discontinued imatinib following HBVr; notably, 1 month after discontinuation, 1 patient experienced HBVr. Antivirals (entecavir n=4, tenofovir n=1), artificial extracorporeal liver support (n=1), and liver transplant (n=1) were effective approaches to treating HBVr. Most patients (n=3) showed favorable progress, 1 patient underwent treatment, and 1 patient died due to severe liver failure induced by HBVr.ConclusionsAlthough HBVr is a rare complication (6.12%), HBV screening should be conducted before starting treatment with imatinib in GIST patients. Prophylactic therapy for hepatitis B surface antigen positive patients, prompt antiviral treatment and cessation of imatinib are also necessary.
Highlights
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms located in the digestive tract, with an estimated annual incidence of 1–2 per 100,000 globally [1, 2]
We retrospectively reviewed the data of 869 patients with GIST from January 2007 to June 2020 through the hospital information system of Xiangya Hospital of Central South University (Changsha, Hunan, China)
Serologic tests for HBV showed that the patient was positive for hepatitis B surface antigen (HBsAg), hepatitis B e-antibody (HBeAb), hepatitis B core antigen (HBcAg) but negative for hepatitis B e-antigen (HBeAg) and hepatitis B surface antibody (HBsAb)
Summary
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms located in the digestive tract, with an estimated annual incidence of 1–2 per 100,000 globally [1, 2]. Since 2000, imatinib has been found to target KIT changes in GIST cells [3]. More than 80% of GIST patients have benefited from treatment with imatinib [4]. This therapy has become one of the standard treatments for GIST [5]. Hepatitis B virus reactivation (HBVr) is a common complication in tumor patients with chronic HBV infection and simultaneously undergoing cytotoxic chemotherapy or immunosuppressive therapy [6]. HBVr in tumor patients may lead to liver function injury or fatal liver failure. This occurrence can interrupt therapy, delaying the effective treatment of tumor patients and affecting prognosis
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