4.2 Review

Hepatitis B virus reactivation in breast cancer patients undergoing chemotherapy: A review and meta-analysis of prophylaxis management

Journal

JOURNAL OF VIRAL HEPATITIS
Volume 24, Issue 7, Pages 561-572

Publisher

WILEY
DOI: 10.1111/jvh.12672

Keywords

breast cancer; hepatitis B; lamivudine; prophylaxis antiviral therapy; reactivation

Funding

  1. Natural Science Foundation of China [81490750, 81230060, 81442009, 81621004, 81272893, 81472466, 81672594]
  2. Key R & D Program of Ministry of Science and Technology of China [2016YFC1302300]
  3. Sun Yat-sen University Innovative Drug R D Project
  4. National Science Foundation of Guangdong Province [2014A03036003, S2012030006287, 2014A030310378, 2015B050501004, 2016A050502018, 2015A030313172, 2016A030313237, 2014A020212059]
  5. Guangzhou Science Technology and Innovation Commission [201508020008, 201508020249, 201504301341501]
  6. Guangdong Science and Technology Department [2015B050501004]
  7. Translational medicine public platform of Guangdong Province [4202037]
  8. Guangdong Department of Science & Technology Translational Medicine Center [2011A080300002]
  9. Elite Young Scholars Program of Sun Yat-sen Memorial Hospital [Y201401]
  10. Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes [KLB09001]
  11. Key Laboratory of Malignant Tumor Molecular Mechanism and Translational Medicine of Guangzhou Bureau of Science and Information Technology [(2013) 163]
  12. China Scholarship Council [201506385074, 201606385034]

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Hepatitis B virus (HBV) reactivation during or after chemotherapy in patients with breast cancer has become a remarkable clinical problem. Prophylactic nucleos(t)ide analogues (NAs) are recommended for patients with breast cancer who are hepatitis B surface antigen (HBsAg) positive before chemotherapy. We performed an up-to-date meta-analysis to compare the efficacy of prophylactic lamivudine use with nonprophylaxis in HBsAg-positive breast cancer patients undergoing chemotherapy. PubMed, the Cochrane Library and China National Knowledge Infrastructure (CNKI) databases were searched for relevant articles until June 2016. Eligible articles comparing the efficacy of prophylactic lamivudine use with nonprophylaxis in HBsAg-positive breast cancer patients undergoing chemotherapy were identified. Eight studies which had enrolled 709 HBsAg-positive breast cancer patients undergoing chemotherapy were analysed. Lamivudine prophylaxis significantly reduced the rates of chemotherapy-associated hepatitis B flares in chronic hepatitis B in breast cancer compared with patients with nonprophylaxis (odds ratio [OR]=0.15, 95% confidence interval [CI]: 0.07-0.35, P<.00001). Chemotherapy disruption rates attributed to HBV reactivation in the prophylaxis groups were significantly lower than the nonprophylaxis groups (OR=0.17, 95% CI: 0.07-0.43, P=.0002). Patients with lamivudine prophylaxis had a higher risk for tyrosine-methionine-aspartate-aspartate (YMDD) motif mutations than patients with nonprophylaxis (OR=6.33, 95% CI: 1.01-39.60, P=.05). Prophylactic antiviral therapy management is necessary for HBsAg-positive breast cancer patients undergoing chemotherapy, in spite of high correlation with lamivudine-resistant HBV variants with YMDD motif mutations.

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