Antivirals Prevent HBV Reactivation After Radiotherapy for Hepatocellular Carcinoma

Preventive therapy against hepatitis B virus (HBV) reactivation is recommended for patients with hepatocellular carcinoma (HCC) who are scheduled to receive radiotherapy (RT), according to a retrospective, multicenter study published in PLoS One.¹

HBV reactivation can occur in patients with chronic hepatitis B, which can lead to premature termination of chemotherapy or can delay treatment schedules in patients with cancer receiving chemotherapy.^2,3 The risk for HBV reactivation after RT in patients with HCC remains unclear; therefore, researchers in South Korea evaluated the medical records of 133 people with HCC who were positive for hepatitis B surface antigen and who received RT from March 2009 to February 2016.¹

Of the total, 27 patients did not receive antiviral therapy before RT and 106 patients underwent antiviral therapy before RT. Overall, HBV reactivation occurred in 17 (12.7%) patients after RT. Those in the antiviral group had significantly lower rates of HBV reactivation than those in the non-antiviral group (7.5% vs 33.3%, respectively; P <.001).

The mean duration of HBV reactivation after RT was 2.3 months. The development of HBV-related hepatitis was also lower in the antiviral group compared with the non-antiviral group (3.8% vs 14.8%, P =.031), which suggests that antiviral treatment can prevent hepatitis after RT. Major risk factors for HBV reactivation during RT are combined treatment of RT with transarterial chemoembolization and non-antiviral treatment.

“In conclusion, HBV reactivation that causes hepatitis can occur after RT in [people with] HCC,” stated the authors.¹ In addition, “Antiviral therapy can reduce HBV reactivation and complications after RT. Therefore, preventive antiviral therapy should be recommended for patients with HCC who are scheduled to receive RT.”

References

1. Jun BG, Kim YD, Kim SG, et al. Hepatitis B virus reactivation after radiotherapy for hepatocellular carcinoma and efficacy of antiviral treatment: a multicenter study. PLoS One. 2018;13(7):e0201316.
2. Lok AS, Liang RH, Chiu EK, Wong K-L, Chan T-K, Todd D. Reactivation of hepatitis B virus replication in patients receiving cytotoxic therapy. Report of a prospective study. Gastroenterology. 1991;100(1):182-188.
3. Yeo W, Chan PK, Hui P, et al. Hepatitis B virus reactivation in breast cancer patients receiving cytotoxic chemotherapy: a prospective study. J Med Virol. 2003;70(4):553-561.