Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2024; 30(24): 3052-3058
Published online Jun 28, 2024. doi: 10.3748/wjg.v30.i24.3052
Risk of hepatitis B virus reactivation in cancer patients undergoing treatment with tyrosine kinase-inhibitors
Bansi P Savaliya, Ramin Shekouhi, Fatima Mubarak, Harsheen K Manaise, Paola Berrios Jimenez, Gabrielle Kowkabany, Reed A Popp, Kyle Popp, Emmanuel Gabriel
Bansi P Savaliya, Department of Surgery, Medical Academy Named after SI Georgievsky of Vernadsky Crimean Federal University, Simferopol 295015, Crimea, Russia
Ramin Shekouhi, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL 32608, United States
Fatima Mubarak, Department of Surgery, Aga Khan University, Karachi 74800, Sindh, Pakistan
Harsheen K Manaise, Department of Surgery, Government Medical College and Hospital, Chandigarh 160030, Punjab, India
Paola Berrios Jimenez, Department of Surgery, University of Puerto Rico School of Medicine, San Juan 00921, Puerto Rico
Gabrielle Kowkabany, Department of Chemical and Biological Engineering, University of Alabama, Tuscaloosa, AL 35487, United States
Reed A Popp, Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, United States
Kyle Popp, Department of Surgery, Florida State University, Tallahassee, FL 32306, United States
Emmanuel Gabriel, Department of Surgery, Mayo Clinic, Jacksonville, FL 32224, United States
Author contributions: Savaliya BP designed the overall concept and outline of the manuscript; Shekouhi R, Mubarak F, Manaise HK, Jimenez PB, Kowkabany G, Popp RA, and Popp K contributed to the design of the manuscript; Savaliya BP, Shekouhi R, Mubarak F, Manaise HK, Jimenez PB, Kowkabany G, Popp RA, Popp K, and Gabriel EM contributed to the writing, editing, and review of literature.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bansi P Savaliya, MD, Doctor, Department of Surgery, Medical Academy Named after SI Georgievsky of Vernadsky Crimean Federal University, 5/7 Lenina Blvd, Simferopol 295015, Crimea, Russia. bansisavaliya33@gmail.com
Received: April 2, 2024
Revised: May 10, 2024
Accepted: May 30, 2024
Published online: June 28, 2024
Processing time: 83 Days and 13.3 Hours
Abstract

This editorial commented on an article in the World Journal of Gastroenterology titled “Risks of Reactivation of Hepatitis B Virus in Oncological Patients Using Tyrosine Kinase-Inhibitors: Case Report and Literature Analysis” by Colapietro et al. In this editorial, we focused on providing a more comprehensive exploration of hepatitis B virus reactivation (HBVr) associated with the usage of tyrosine kinase inhibitors (TKIs). It includes insights into the mechanisms underlying HBV reactivation, the temporal relationship between TKIs and HBV reactivation, and preventive measures. The aim is to understand the need for nucleos(t)ide analogs (NAT) and serial blood tests for early recognition of reactivation and acute liver injury, along with management strategies. TKIs are considered to be an intermediate (1%-10%) of HBVr. Current guidelines stipulate that patients receiving therapy with high or moderate risks of reactivation or recent cancer diagnosis must have at least tested hepatitis B surface antigen, anti-hepatitis B core antigen (HBc), and anti-hepatitis B surface antibody. Anti-HBc screening in highly endemic areas means people with negative tests should be vaccinated against HBV. Nucleoside or nucleotide analogs (NAs) like entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF) form the basis of HBV reactivation prophylaxis and treatment during immunosuppression. Conversely, lamivudine, telbivudine, and adefovir are generally discouraged due to their reduced antiviral efficacy and higher risk of fostering drug-resistant viral strains. However, these less effective NAs may still be utilized in cases where ETV, TDF, and TAF are not feasible treatment options.

Keywords: Hepatitis B virus; Reactivation; Chronic hepatitis B; Tyrosine-kinase inhibitor; Immunomodulators; Immunosuppressant; Nucleoside analogue; Hemato-oncology

Core Tip: Hepatitis B virus reactivation (HBVr) remains a major concern in patients treated with Immunosuppressants and immunomodulators in oncological settings. Patients harboring either overt or occult HBV infection may encounter HBV reactivation during immunosuppressive therapy. The likelihood of HBV reactivation is linked to the patient’s immune status and the initial condition of HBV infection. Depending on the risk, reactivation can be classified as low (< 1%), intermediate (1%-10%), and high (> 10%), It is important to administer nuclei(t)side analogs of high genetic barriers before and during antineoplastic treatment to prevent reactivation. The safety and effectiveness of immunomodulators are investigated. However, during treatment, clinical monitoring of liver enzymes and HBV DNA is required, and a prospective study is needed to determine appropriate antiviral therapy.