Preventive treatment helps avoid Hepatitis B relapse during chemotherapy

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Public release date: 1-Feb-2006

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Preventive treatment helps avoid Hepatitis B relapse during chemotherapy

A new study on treating hepatitis B patients who have cancer with an

antiviral drug at the same time as they undergo chemotherapy found that the

treatment helped prevent relapse of hepatitis B.

The results of this study appear in the February 2006 issue of Hepatology,

the official journal of the American Association for the Study of Liver

Diseases (AASLD). Published by Wiley & Sons, Inc., Hepatology is

available online via Wiley InterScience at

http://www.interscience.wiley.com/journal/hepatology.

Patients who develop hepatocellular carcinoma (HCC), a type of liver cancer

caused by the hepatitis B virus, have up to a 55 percent chance of having

the virus reactivated during chemotherapy. The idea of preemptively treating

these patients with the antiviral drug lamivudine in order to prevent

hepatitis B relapse and it varying complications is promising but has never

been investigated in patients with HCC.

Researchers led by Jeong Won Jang of the Department of Internal Medicine at

the Catholic University of Korea in Seoul, conducted a prospective

randomized study on pretreating HCC patients undergoing chemotherapy with

lamivudine between January 2004 and February 2005. The study involved 36

patients with HCC who were given the drug while undergoing transarterial

chemo-lipiodolization (TACL) chemotherapy and a control group of 37 patients

who underwent the chemotherapy without receiving lamivudine. The

chemotherapy was continued every month without any limit on the number of

cycles until the tumors disappeared, while treatment with lamivudine began

with the chemotherapy and continued for 12 months following its completion.

In total, 43 percent of the patients in the control group developed overall

clinical hepatitis during the follow-up period, compared to 17 percent of

the patients who took lamivudine. In addition, there was a significantly

higher incidence of severe hepatitis in the control group and the

researchers established the level of viral load (>104 copies/ml) that

predicted whether a patient would have a relapse of hepatitis B.

In addition to demonstrating that treatment with lamivudine significantly

reduced hepatitis B reactivation, allowing chemotherapy to continue in these

cancer patients, the study suggests that lamivudine therapy decreases the

severity of clinical hepatitis if it develops during chemotherapy. " The

beneficial effects of preemptive therapy on the severity of hepatitis most

probably result from an elimination of any potential risk arising from viral

reactivation, " the authors state.

While previous studies have shown a higher viral load as a predictor of

hepatitis B reactivation, the lower cutoff in the current study was

identified as a better predictor and the authors urge the use of a highly

sensitive test to detect and measure viral load in order to identify

patients at the greatest risk of hepatitis B reactivation. In those patients

with lower viral loads, it would still be beneficial to closely monitor

virological and biochemical changes when they are undergoing repeated

courses of chemotherapy, since the study demonstrated that even lower viral

loads are associated with an approximately 30 percent risk of viral

reactivation.

Although the study did not examine long-term survival in the patients who

took lamivudine, the authors conclude: " Given that preemptive antiviral

therapy ameliorates the hepatic morbidity seen during transarterial

chemotherapy and facilitates further chemotherapy without disruptions in the

treatment schedules, the expectation would be for an increased chance of

survival with this approach. "

###

Article: " A Randomized Controlled Study of Preemptive Lamivudine in Patients

Receiving Transarterial Chemo-Lipiodolization, " Jeong Won Jang, Jong Young

Choi, Si Hyun Bae, Seung Kew Yoon, U Im Chang, Chang Wook Kim, Se Hyun Cho,

Jun Yeol Han, Young Sok Lee, Hepatology; February 2006 (DOI:

10.1002.hep.21024).

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