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.

Keywords: Chronic hepatitis B; Reactivation; Nucleoside analogue; Tyrosine kinase inhibitors; Onco-hematology

Core Tip: Hepatitis B virus reactivation (HBVr) is a clinical challenge among patients receiving chemotherapy for solid tumors or hematologic malignancies. The emergence of novel immunosuppressive and immunomodulatory agents requires expertise in delineating the risk of HBVr associated with each drug class. Classifying the risk of HBVr into low (< 1%), intermediate (1%-10%) and high (> 10%) allows physicians to understand in whom nucleos(t)ide analogues (NAs) are required to avoid potential progression to liver failure and death. To note, according to guidelines, patients without immediate indication for NAs should undergo serial monitoring of blood test for transaminases and HBV profile, including hepatitis B surface antigen status and HBV-DNA titer.