Updated longitudinal data on acute exacerbation of chronic hepatitis B in patients with breast cancer receiving anthracycline-based adjuvant chemotherapy: Therapeutic versus preemptive use of lamivudine.

Abstract

Background: Following our previous report on acute exacerbation (AE) of chronic hepatitis B (CHB) in breast cancer patients receiving anthracyline-based adjuvant chemotherapy (Kim MK et al, Kor J of Int Med 2007), updated longitudinal data were analyzed focusing on therapeutic and preemptive use of lamivudine. Methods: Records of 3,259 patients at Asan Medical Center between Aug 2001 and Nov 2009 were reviewed. The level of ALT was graded by CTCAE version 3.0. Hepatitis by HBV reactivation was defined as a ≥ 10-fold increase in HBV DNA level compared with baseline or an absolute increase of >105 copies/mL. Results: Total 169 patients with positive HBsAg at the start of adjuvant chemotherapy were chosen. Overall, 19 (14.8%) of 128 patients without lamivudine prophylaxis (LP), and 2 (4.9%) of 41 with LP experienced AE of CHB during adjuvant chemotherapy. The old age (≥55) was the only significant predictive factor for AE of CHB (p=0.040) with multivariate analysis. Conclusions: Preemptive use of lamivudine in patients with breast cancer receiving adjuvant anthracycline-based chemotherapy could reduce the incidence of Gr 3, 4 elevated ALT and hepatitis flare-up. The age (≥55) at the initiation of adjuvant chemotherapy was an independent factor to predict AE of CHB. Patient characteristics and features of hepatitis Lamivudine−N=128 (%) Lamivudine +N=41 (%) p value Median age 46 48 NS Chemotherapy NS AC 82 (64.1) 21 (51.2) AC+T 46 (35.9) 20 (48.8) Median ALT 18 18 NS Median total bilirubin 0.7 0.8 NS Level of ALT 0.023 Gr 1,2 21 (16.4) 10 (24.4) Gr 3,4 24 (18.8) 2 (4.9) Type of hepatitis (> 3X ULN) 0.005 HBV related 19 (14.8) 2 (4.9) 0.108 (0.047)* Nonviral, toxic 23 (18.0) 1 (2.4) 0.010 Onset (after cycle) 4 (1–8) 4 (1–8) NS Time to resolution (days) 35 (5–179) 7 (2–753) NS Treatment interruption NS > 1 wks of delay 20 (15.6) 4 (9.8) Discontinuation 12 (9.4) 1 (2.4) * If excluding one lamivudine-resistant strain (M204V/I, L180M). No significant financial relationships to disclose.