Fatal hepatitis B reactivation in a patient receiving chemoradiation for cervical cancer

Abstract

Introduction Hepatitis B virus (HBV) infection remains a global public health threat, with approximately 257 million people suffering from chronic HBV infection worldwide in 2015. HBV reactivation is a known complication of immunosuppressive therapy in people suffering with chronic HBV. Medications commonly associated with HBV reactivation include B-cell depleting agents and anthracycline derivatives. There have been very few documented cases of chemoradiation inducing HBV reactivation among scientific literature. Case report A 44-year-old woman with chronic HBV infection and [FIGO] stage IIIB cervical cancer developed marked transaminitis and increased HBV viral load after receiving treatment with three doses of cisplatin and one dose of carboplatin with concurrent radiation for cervical cancer. Management and outcome: The patient was admitted for acute liver failure and quickly developed encephalopathy, with treatment complicated by coagulopathy, hypoglycemia, and metabolic acidosis. The patient remained unresponsive to maximal therapeutic efforts and was mechanically ventilated for airway protection. She subsequently died after experiencing ventricular tachycardia followed by asystole. Discussion There are currently no standardized guidelines for the screening of HBV infection or prophylaxis treatment algorithm for patients undergoing chemoradiation. When initiating treatment with immunosuppressive therapy, it is important to screen all patients for chronic HBV infection and to work with an interdisciplinary team of oncologists, hepatologists, and pharmacists to initiate prophylactic antiviral therapy and closely monitor to minimize the risk of HBV reactivation.

Hepatitis B Virus Reactivation Following Treatment of HNSCC With Cisplatin

“…The only known case associated with solely cisplatin or other platinums was published which detailed treatment of cervical cancer with chemotherapy with cisplatin and radiation but also involved carboplatin. 11 There is another case described which details a patient with pancreatic cancer and liver metastases treated with cisplatin and gemcitabine. 12 Most important is to start Entecavir as soon as hepatitis B reactivation is diagnosed or prior to start of immunosuppression including chemotherapy per AGA guidelines.…”

Antiviral therapy use and related outcomes in patients with cancer and viral infections: results from SWOG S1204

“…Patients with viral infections receiving systemic anticancer therapy remain at risk for adverse clinical outcomes if antiviral therapy and management guidance are not followed. For example, recent reports show that reactivation is still occurring in HBV patients receiving chemoradiation for cervical cancer [ 16 ]; that anti-CD19 chimeric antigen receptor (CAR) T-cell therapy can cause HBV reactivation in patients with B-cell malignancies and chronic [ 17 ] or past HBV infection [ 18 ], and the administration of this therapy may require heightened awareness on the part of providers who care for patients coinfected with HBV and HIV since CAR T-cell therapy may be a novel treatment for HIV [ 19 ]; and that dexamethasone and tocilizumab for treatment of COVID-19 may increase the risk of HBV reactivation [ 20 ].…”