Korean J Intern Med.
2007 Dec;22(4):237-243. 10.3904/kjim.2007.22.4.237.
Hepatitis B Reactivation During Adjuvant Anthracycline-Based Chemotherapy in Patients with Breast Cancer: A Single Institution's Experience
- Affiliations
-
- 1Division of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. wkkim@amc.seoul.kr
- 2Division of Gastroenterology, Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
- 3Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
- 4Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
- 5Diagnostic Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
- 6Department of Medicine, Yeungnam University College of Medicine, Daegu, Korea.
- KMID: 1776674
- DOI: http://doi.org/10.3904/kjim.2007.22.4.237
Abstract
- BACKGROUND: The objectives of this study were to determine the incidence, outcome and risk factors for HBV reactivation in HBsAg positive breast cancer patients while on anthracycline -based adjuvant chemotherapy. METHDOS: We retrospectively reviewed the records of 2,431 patients with early breast cancer who received adjuvant chemotherapy from March 2001 to December 2005. Among these patients, 111 HBsAg positive women were enrolled in this study. RESULTS: Thirty-seven patients (33.3%) developed acute hepatitis, of which 23 (20.7%) were related to HBV reactivation. Univariate analysis showed that an age > or =47 years (p=0.034) and abnormal sonographic findings such as a fatty liver or cirrhotic changes (p=0.034) were associated with HBV reactivation. However, an HBeAg positive status and the use of corticosteroids were not. Multivariate analysis found that no clinical factors could predict HBV reactivation during chemotherapy. All 23 patients who developed HBV reactivation received lamivudine as a therapeutic measure at the time of HBV reactivation. Despite the use of lamivudine, disruption in the chemotherapy protocol occurred in 18 patients (78.3%) and 14 of these patients had premature termination of their chemotherapy. CONCLUSIONS: HBV reactivation occurred in a significant proportion of HBsAg positive patients during adjuvant anthracycline-based chemotherapy. Once hepatitis developed, most patients could not finish the chemotherapy as planned despite lamivudine treatment. Until the risk factors for reactivation are clearly identified, HbsAg-positive patients should begin prophylactic antiviral treatment before initiating chemotherapy.
Keyword
MeSH Terms
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Adult
Aged
Anthracyclines/*adverse effects
Antineoplastic Agents/*adverse effects
*Antineoplastic Combined Chemotherapy Protocols
Breast Neoplasms/*drug therapy
Chemotherapy, Adjuvant/*adverse effects
Female
Hepatitis B/epidemiology/*etiology
Humans
Incidence
Korea/epidemiology
Middle Aged
Retrospective Studies
Risk Factors
*Treatment Outcome
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