Reactivation of Hepatitis B Virus Among Patients With Cancer Receiving Immunotherapy

Hwang, Jessica P.; Yılmaz, Bülent

doi:10.36401/jipo-20-19

Cited by 5 publications

(4 citation statements)

References 18 publications

(12 reference statements)

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“…Furthermore, several isolated cases of anti-PD-1 immunotherapy-related HBV reactivation in patients with resolved HBV infection have been reported (16,17,37). These findings suggest that both patients with chronic HBV and resolved HBV infection are at risk of virus reactivation while receiving PD-(L)1 blockade, and that screening for HBV in all patients should be performed before treatment begins (38). It's worth noting that, though widely observed in clinical practice, the mechanism of HBV reactivation induced by anti-PD-1/PD-L1 therapy is still unclear.…”

Section: Pd-1 Pathway Inhibitors Have Become a Cornerstone In The Treatment Of Patients With Nononcogene Addicted Advancedmentioning

confidence: 95%

Association of hepatitis B virus infection status with outcomes of non-small cell lung cancer patients undergoing anti-PD-1/PD-L1 therapy

Zhang¹,

Tian²,

Chen³

et al. 2021

Transl Lung Cancer Res

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Background: The aim of this study was to evaluate the safety and survival outcomes of anti-programmed cell death (PD)-1/programmed cell death-ligand 1 (PD-L1) monotherapy in patients with advanced nonsmall cell lung cancer (NSCLC) and different hepatitis B virus (HBV) infection status.Methods: Patients with advanced NSCLC and both chronic and/or resolved HBV infection who were treated with anti-PD-(L)1 monotherapy were retrospectively enrolled. The primary endpoint was the safety of PD-1/PD-L1 monotherapy, while the secondary endpoints included the survival outcomes.Results: Of the 62 eligible patients, 10 (16.1%) were hepatitis B surface antigen (HBsAg) positive [chronic hepatitis B (CHB) infection] and 52 (83.9%) were HBsAg negative and HBcAb positive [resolved hepatitis B (RHB) infection]; 42 (67.7%) patients had at least 1 treatment-related adverse event (AE), with 4 patients (6.5%) developing grade 3 AEs and 6 (9.7%) developing hepatic AEs. One CHB patient experienced HBV reactivation during anti-PD-1 immunotherapy due to the interruption of antiviral prophylaxis. The objective response rate and durable clinical benefit (DCB) rate were 17.7% and 29.0%, respectively. Median overall survival (OS) and progression-free survival (PFS) were 23.6 months [95% confidence interval (CI): 14.4-32.8] and 2.1 months (95% CI: 1.2-3.0), respectively. The DCB rate was significantly higher in the CHB group than in the RHB group (60% vs. 23.1%; P=0.048). Patients with CHB experienced a longer PFS (8.3

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Section: Pd-1 Pathway Inhibitors Have Become a Cornerstone In The Treatment Of Patients With Nononcogene Addicted Advancedmentioning

confidence: 95%

Association of hepatitis B virus infection status with outcomes of non-small cell lung cancer patients undergoing anti-PD-1/PD-L1 therapy

Zhang¹,

Tian²,

Chen³

et al. 2021

Transl Lung Cancer Res

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“…While ICIs have revolutionized the treatment landscape of several cancers, patients with chronic hepatitis are often excluded from receiving immunotherapy due to potential risk for viral reactivation. 5 , 18–20 In addition, conflicting data on efficacy of ICIs to reinvigorate the T cells that are in a state of exhaustion due to persistent viral stimulation has dampened research in this area. 21 As the available evidence on the safety and efficacy of ICIs in this high-risk population is limited, the key question, “Will this therapy lead to further immune dysregulation in those patients who are already at higher risk for autoimmunity?” still remains.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Immune Checkpoint Inhibitors in Patients with Cancer and Viral Hepatitis: The MD Anderson Cancer Center Experience

et al. 2023

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Background Despite the clinical benefit of immune checkpoint inhibitors (ICIs), patients with a viral hepatitis have been excluded from clinical trials because of safety concerns. The purpose of this study was to determine the incidence rate of adverse events (AEs) in patients with viral hepatitis who received ICIs for cancer treatment. Materials and Methods We conducted a retrospective study in patients with cancer and concurrent hepatitis B or C, who had undergone treatment with ICI at MD Anderson Cancer Center from January 1, 2010 to December 31, 2019. Results Of the 1076 patients screened, we identified 33 with concurrent hepatitis. All 10 patients with HBV underwent concomitant antiviral therapy during ICI treatment. Sixteen of the 23 patients with HCV received it before the initiation of ICI. The median follow-up time was 33 months (95% CI, 23-45) and the median duration of ICI therapy was 3 months (IQR, 1.9-6.6). Of the 33 patients, 12 (39%) experienced irAEs (immune-related adverse events) of any grade, with 2 (6%) having grade 3 or higher. None of the patients developed hepatitis toxicities. Conclusion ICIs may be a therapeutic option with an acceptable safety profile in patients with cancer and advanced liver disease.

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“…An important review was published in 2021 with a recommendation to screen all the patients before ICI administration for serologic tests of HBV infection, including HbsAg, anti-Hbc, total IgG, and anti-HBs in order to identify all patients at risk of HBV reactivation to whom antiviral prophylaxis is strongly advised ( 20 ). This recommendation involves changes in practice and requires efforts in the field of oncologists’ education.…”

Section: Human Immunodeficiency and Hepatitis B And C Virusmentioning

confidence: 99%

Viral Infection and Lung Cancer Immunotherapy

2021

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Immunotherapy with immune checkpoint inhibitors (mainly anti-PD1 and anti-PDL1 monoclonal antibodies) became a standard of care in non-small cell lung cancer (NSCLC) patients. Most of the clinical trials excluded patients with hepatitis B (HBV), hepatis C (HCV), and human immunodeficiency virus (HIV) active infection (1–10). Despite the progress in treatment of these infections, they remain an unresolved clinical problem when lung cancer immunotherapy should be initiated in an NSCLC patient. This manuscript summarizes the data from the literature concerning this subgroup of patients including the rationale for immunotherapy initiation depending on the HBV, HCV, or HIV infection status; the risk of adverse events; and the efficacy compared to non-infected patients. One of the crucial questions is how the candidates to immunotherapy should be screened for HBV, HCV, and HIV infections. The year 2020 brought the world a new but dynamic viral problem—severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). The incorporation of known data in oncology guidelines became a burning need, and then, which group of the infected patients can be treated with immunotherapy despite the infection. Oncologists should also know if these patients should receive antiviral therapy and what are the safe combinations in these settings. We also indicate which of the adverse events should be monitored carefully during checkpoint inhibitor treatment.

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Reactivation of Hepatitis B Virus Among Patients With Cancer Receiving Immunotherapy

Cited by 5 publications

References 18 publications

Association of hepatitis B virus infection status with outcomes of non-small cell lung cancer patients undergoing anti-PD-1/PD-L1 therapy

Association of hepatitis B virus infection status with outcomes of non-small cell lung cancer patients undergoing anti-PD-1/PD-L1 therapy

Safety and Efficacy of Immune Checkpoint Inhibitors in Patients with Cancer and Viral Hepatitis: The MD Anderson Cancer Center Experience

Viral Infection and Lung Cancer Immunotherapy

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