Hepatitis B Reactivation After Administration of Pembrolizumab (KEYTRUDA): A Unique Case Report

Ragunathan, Karthik; Dadana, Sriharsha; Huang, Ching-Ho

doi:10.14309/00000434-201710001-02146

Cited by 9 publications

(9 citation statements)

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“…This case is very unique in two aspects. First, to our knowledge, there is only one case reported of pembrolizumab-induced hepatitis B reactivation [ 5 ]. In addition, our patient also had immune-mediated hepatitis induced by pembrolizumab.…”

Section: Discussionmentioning

confidence: 99%

Pembrolizumab-Induced Immune-Mediated Hepatitis and Concurrent Hepatitis B Reactivation in a Patient With Non-Small Cell Lung Cancer

Kundumadam

Mohamad

Muthusamy³

et al. 2020

Cureus

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New immuno-therapeutic agents like pembrolizumab used in cancer treatment are known to cause immune-mediated hepatitis. Most of these cases are straightforward when the onset of transaminitis correlates with the introduction of the medication. This agent causing hepatitis B reactivation has been reported only once. To have both these adverse effects occurring at the same time in a patient is uncommon and presents a clinical challenge. Our patient was a 49-year-old gentleman diagnosed with metastatic adenocarcinoma of the lung seven months ago. He was started on pembrolizumab, as the malignant tissue obtained during biopsy had high program death-ligand 1 (PDL1) expression. On reviewing the labs ordered during the time of cancer diagnosis, this man has evidence of chronic hepatitis B with positive hepatitis B surface antigen and positive hepatitis B core immunoglobulin G (IgG) antibody. He presented with acute hepatitis, and workup showed features of hepatitis B reactivation, but the extent of reactivation was not adequate to explain the presentation, hence investigations were pursued. This led the way to the diagnosis of a combined hepatitis B reactivation and drug-induced immune hepatitis in this case. He responded promptly to the withdrawal of the agent and steroids. On follow-up, his liver function panel had significantly improved. This case is very unique in two aspects. First, to our knowledge, there is only one case reported of pembrolizumab-induced hepatitis B reactivation. In addition, our patient also had immune-mediated hepatitis induced by pembrolizumab. It is very rare to have a combination of these two presentations to be seen in a patient at the same time. Pembrolizumab-induced immune hepatitis can coexist with hepatitis B reactivation following therapy with this agent.

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Section: Discussionmentioning

confidence: 99%

Pembrolizumab-Induced Immune-Mediated Hepatitis and Concurrent Hepatitis B Reactivation in a Patient With Non-Small Cell Lung Cancer

Kundumadam

Mohamad

Muthusamy³

et al. 2020

Cureus

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“…Three (42.8%) were treated with Pembrolizumab, 2 (28.6%) for NSCLC and 1 (14.3%) for malignant melanoma. 13 , 15 , 16 Time to HBVr was reported in one patient on Pembrolizumab which was 28 weeks, and that patient was known to have chronic HBV. 13 One patient on Pembrolizumab received Tenofovir, 1 did not receive an antiviral, and antiviral coverage was not reported in 1 case report.…”

Section: Resultsmentioning

confidence: 99%

“… 13 One patient on Pembrolizumab received Tenofovir, 1 did not receive an antiviral, and antiviral coverage was not reported in 1 case report. 13 , 15 , 16 Immunotherapy was delayed in 1 patient. 15 Mean time for an undetectable viral load when reported was 7.5 weeks after diagnosis.…”

Section: Resultsmentioning

confidence: 99%

Hepatitis B Virus Reactivation in Cancer Patients Treated With Immune Checkpoint Inhibitors

Burns

Muhsen

Anand³

et al. 2021

Journal of Immunotherapy

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“…Four case-reports of HBV reactivation during ICI treatment have been published so far ( Table 1 ) [12][13][14][15] . Three were related to ICI targeting anti-PD1 (pembrolizumab or nivolumab) and one to ipilimumab (anti-CTLA4).…”

Section: Real Life Evidencementioning

confidence: 99%

“…Three were related to ICI targeting anti-PD1 (pembrolizumab or nivolumab) and one to ipilimumab (anti-CTLA4). Two patients had no documented HBV status before the start of ICI [12 , 15] , and one patient experienced a seroconversion [13] .Three patients recovered after antiviral treatment (tenofovir (TFV)) [12][13][14] , whereas one patient only received corticosteroids, with an unspecified outcome [15] .…”

Section: Real Life Evidencementioning

confidence: 99%

Hepatitis B reactivation and immune check point inhibitors

Godbert¹,

Petitpain

Lopez

et al. 2021

Digestive and Liver Disease

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Background: Liver toxicity during immune checkpoint inhibitor treatment is mostly due to immune mediated hepatitis. Viral hepatitis, as well as auto-immune or metabolic hepatitis, are considered as exclusion criteria for ICI induced immune hepatitis diagnosis. However, considering the high prevalence of viral hepatitis B infection and the increasing prescription of immune checkpoint inhibitors, their use in patients with HBV chronic viral infection may be common, even more if patients are treated for hepatocellular carcinoma. Few clinical studies directly deal with the risk of HBV reactivation during ICI therapy and real-life data is currently based on five reported cases of HBV reactivation, one with fatal outcome.In this review, we summarize the current available clinical information about HBV reactivation risk during ICI treatment, its hypothetic mechanism, and propose practical recommendations about verifying and monitoring HBV status throughout the treatment.

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Hepatitis B Reactivation After Administration of Pembrolizumab (KEYTRUDA): A Unique Case Report

Cited by 9 publications

References 0 publications

Pembrolizumab-Induced Immune-Mediated Hepatitis and Concurrent Hepatitis B Reactivation in a Patient With Non-Small Cell Lung Cancer

Pembrolizumab-Induced Immune-Mediated Hepatitis and Concurrent Hepatitis B Reactivation in a Patient With Non-Small Cell Lung Cancer

Hepatitis B Virus Reactivation in Cancer Patients Treated With Immune Checkpoint Inhibitors

Hepatitis B reactivation and immune check point inhibitors

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