Risk of hepatitis B virus reactivation in oncological patients treated with tyrosine kinase inhibitors: A case report and literature analysis

Abstract

Hepatitis B virus (HBV) reactivation (HBVr) represents a severe and potentially life-threatening condition, and preventive measures are available through blood test screening or prophylactic therapy administration. The assessment of HBVr traditionally considers factors such as HBV profile, including hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen, along with type of medication (chemotherapy; immunomodulants). Nevertheless, consideration of possible patient’s underlying tumor and the specific malignancy type (solid or hematologic) plays a crucial role and needs to be assessed for decision-making process.

Risk of hepatic decompensation from hepatitis B virus reactivation in hematological malignancy treatments

“…The apparent discrepancy between the conclusions of Colapietro et al [ 1 ], based on their case report, two other case reports, and the recent study of Chiu et al [ 7 ], and the data from literature published from 2016-2022 can be explained making use of different considerations. First, different hematologic malignancies and different types of therapies (first-generation or second-generation TKI and BTK inhibitors) were reported in the studies; second, the patients participating in the studies were from different geographical areas, which is an aspect linked to both ethnicity and HBV genotype.…”

“…One of the two patients was 92-years-old, and both patients had previously received anti-CD20 monoclonal antibodies as first-line therapy. Interestingly, acalabrutinib was the same BTK inhibitor used by Colapietro et al [ 1 ].…”

“…In their letter, Colapietro et al [ 1 ] discussed a single case of hepatitis B virus reactivation (HBVr) in a patient with chronic lymphocytic leukemia undergoing therapy with a Bruton’s tyrosine kinase (BTK) inhibitor. Based on both their findings and a summary of literature data, they issued a warning on the use of tyrosine kinase inhibitors (TKIs) in this clinical setting.…”

“…This article opens up an important debate on the topic, if we consider that their patient developed hepatic decompensation. In this editorial, we introduced some additional aspects that contribute to enriching the discussion on this topic, attempting to provide an explanation for the apparent discrepancy between the findings described by Colapietro et al [ 1 ] and the most recent literature data on the risk of HBVr in a patient with hematologic malignancies (Table 1 )[ 2 - 9 ].…”

Risk of hepatitis B virus reactivation in cancer patients undergoing treatment with tyrosine kinase-inhibitors

“…The intensity of immunosuppression depends mainly on the type, dose, and duration of the immunosuppression therapy. Based on the type of immunosuppressive therapy, the risk of reactivation can be broadly categorized into high risk (≥ 10%), moderate risk (between 1%-10%), and low risk (< 1%)[ 12 ]. In the clinical practice guidelines, TKI was classified as a moderate-risk class (1%-10%) of HBV reabsorption.…”