Title : The risk of hepatitis B reactivation during immunosuppressive therapy in B-cells cancers: The role of antiviral prevention
Abstract:
Background : Patients receiving immunosuppressive therapy for B-Cell cancers such as lymphoma and leukemia, may be at an increased risk for reactivation of Hepatitis B infections. Immune Checkpoint Inhibitors,(ICIs), weakens immune responses that control latent viruses. Reactivation of Hepatitis B leads to disruption of necessary cancer treatment, liver complications, increased morbidity. This qualitative study assesses clinical data to observe whether antiviral medications may reduce the likelihood of the reactivation of Hepatitis B in patients due to treatments for B-cell cancers, and to examine clinical strategies that can be used to manage these issues.
Materials and Methods: A qualitative review was carried out to evaluate the risk of Hepatitis B reactivation in patients with B-Cell malignancies who are currently receiving immunosuppressive Treatments. Literature included viral infection reactivation rates, antiviral treatments, and treatment outcomes. Specific data sets were reviewed comprising of 1,057 patients with chronic Hepatitis B infection receiving ICI, while another study reviewed 633 patients with Hepatitis B infection and cancer who are also undergoing ICI therapy. Across these trials, reactivation incidents were evaluated and statistical comparisons were made between patients receiving antiviral treatments and those who weren’t. These clinical trials revealed that reactivation was statistically higher for patients with chronic Hepatitis B infection compared to those without. Additionally, a multinational survey of 56 oncology centers throughout Europe including Italy, France, and Spain assessed the clinical practices needed in order to manage patients suffering from Hepatitis B, allowing them to receive immunotherapy.
Results: Across examined studies, reactivation was statistically higher in those with chronic infection compared to those with a past infection. It was evident that the absence of antiviral treatments was associated with increased rates of reactivation risk. Antiviral prophylaxis significantly reduced the risk of viral reactivation. HBV prophylaxis is recommended by European and American medical societies, for managing HBV infection in patients receiving ICIs. It is clear that screening cancer patients for HBV before beginning ICIs is crucial. By monitoring HBV biomarkers, it reduces the likelihood of complications and inhibits potential mortality amongst these patients.
Conclusions: Our qualitative study concluded that cancer treatment with ICIs has been associated with the reactivation of the Hepatitis B virus, particularly among patients with chronic infection. When antiviral prophylaxis is not administered to patients, studies show the clinical studies we reviewed reflected that there is a significantly higher rate of reactivation without prophylaxis compared to minimum rates of reactivation for patients receiving prophylaxis treatment. Across examined studies, cancer patients receiving immunotherapies reflected relatively low reactivation rates, yet almost all cases occurred in patients with chronic HBV infection. HBV screening before initiation of Immunotherapy or ICI treatment is crucial. Consequently, expansion of screening and antiviral therapy may reduce hepatitis reactivation incidents during Immunosupressive treatment in patients with B cell cancers. Therefore the conclusion of our qualitative study emphasizes that patients who are receiving antiviral treatments are not likely to have reactivation of Hepatitis B. Strategically, European Oncologists are in the process of developing methodical and systematic treatment improvements aiming at optimum treatment outcomes.
