Hepatitis B virus reactivation in hepatocellular carcinoma patients after hepatic arterial infusion chemotherapy combined with and without immunotherapy

IF 3.1 2区医学 Q3 IMMUNOLOGY

Infectious Agents and Cancer Pub Date : 2024-04-30 DOI:10.1186/s13027-024-00574-7

Lijie Zhang, Yiming Liu, Songlin Song, Joyman Makamure, Heshui Shi, Chuansheng Zheng, Bin Liang

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引用次数: 0

Abstract

Hepatitis B virus (HBV) reactivation (HBVr) is a major concern for hepatocellular carcinoma (HCC) patients undergoing hepatic arterial infusion chemotherapy (HAIC) using mFOLFOX6 regimen. There is insufficient evidence to support the routine use of HAIC combined with immunotherapy in HCC patients with HBVr. The aim of this study was to examine the adverse events (AEs) related to HBVr in HCC patients after HAIC, with or without immunotherapy, and to assess the effectiveness of antiviral prophylaxis for HBVr. Medical records of HCC patients receiving HAIC combined with and without immunotherapy between January 2021 and June 2023 were reviewed. The patients were divided into two groups based on whether they received immunotherapy or not. Out of the 106 patients, 32 (30.2%) developed HBVr. Among these, 23 eligible patients with HBVr were included, with 14 patients (61%) receiving immunotherapy and nine patients (39%) not receiving immunotherapy. Prior to HAIC treatment, four patients in each group had detectable HBV DNA with median titre of 3.66 × 102 IU/ml (patients with immunotherapy) and 1.98 × 102 IU/ml (patients without immunotherapy), respectively. Fifteen patients did not show detectable HBV DNA. At HBVr occurrence, the median HBV DNA level was 6.95 × 102 IU/ml for all patients, 4.82 × 102 IU/ml in patients receiving immunotherapy and 1.3 × 103 IU/ml in patients not receiving immunotherapy. Grade 3 hepatitis developed in 12 cases of all patients (12/23, 48%), including five patients with immunotherapy (56%) and seven patients without immunotherapy (78%). At the 3-month follow-up, HBV DNA was detected in 10 patients, with a median HBV DNA level of 2.05 × 102 IU/ml (range, 1.5 × 102– 3.55 × 102 IU/ml) in patients (7/10) with immunotherapy and 4.28 × 102 IU/ml (range, 1.15 × 102– 5.88 × 102 IU/ml) in patients (3/10) without immunotherapy. Intensified antiviral treatment was administered to all patients. No HBVr-related fatal events occurred. HBVr can occur after HAIC combined with or without immunotherapy. The degree of liver damage did not differ significantly in patients treated with or without immunotherapy. Intensified antiviral treatment was found to be crucial for HCC patients with HBVr.

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肝动脉灌注化疗联合或不联合免疫疗法后肝细胞癌患者的乙肝病毒再激活情况

乙型肝炎病毒（HBV）再活化（HBVr）是接受肝动脉灌注化疗（HAIC）和 mFOLFOX6 方案治疗的肝细胞癌（HCC）患者最担心的问题。目前还没有足够的证据支持对患有 HBVr 的 HCC 患者常规使用 HAIC 联合免疫疗法。本研究的目的是检测HCC患者在接受HAIC后（无论是否接受免疫治疗）发生的与HBVr相关的不良事件（AEs），并评估HBVr抗病毒预防措施的有效性。研究人员回顾了2021年1月至2023年6月期间接受HAIC联合免疫疗法或未接受免疫疗法的HCC患者的医疗记录。根据是否接受免疫治疗将患者分为两组。在 106 例患者中，32 例（30.2%）出现了 HBVr。其中，23 名符合条件的 HBVr 患者被纳入其中，14 名患者（61%）接受了免疫疗法，9 名患者（39%）未接受免疫疗法。在接受HAIC治疗前，每组各有4名患者检测到HBV DNA，滴度中位数分别为3.66×102 IU/ml（接受免疫治疗的患者）和1.98×102 IU/ml（未接受免疫治疗的患者）。有 15 例患者未检测到 HBV DNA。在 HBVr 发生时，所有患者的 HBV DNA 水平中位数为 6.95 × 102 IU/ml，接受免疫治疗的患者为 4.82 × 102 IU/ml，未接受免疫治疗的患者为 1.3 × 103 IU/ml。所有患者中有 12 例（12/23，48%）发展为 3 级肝炎，其中接受免疫治疗的患者有 5 例（56%），未接受免疫治疗的患者有 7 例（78%）。在 3 个月的随访中，10 名患者检测到了 HBV DNA，其中接受免疫治疗的患者（7/10）的 HBV DNA 中位水平为 2.05 × 102 IU/ml（范围为 1.5 × 102- 3.55 × 102 IU/ml），未接受免疫治疗的患者（3/10）的 HBV DNA 中位水平为 4.28 × 102 IU/ml（范围为 1.15 × 102- 5.88 × 102 IU/ml）。所有患者都接受了强化抗病毒治疗。没有发生与 HBVr 相关的死亡事件。HAIC联合或不联合免疫治疗后都可能出现HBVr。接受或不接受免疫治疗的患者的肝损伤程度没有明显差异。加强抗病毒治疗对患有 HBVr 的 HCC 患者至关重要。

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来源期刊

Infectious Agents and Cancer ONCOLOGY-IMMUNOLOGY

CiteScore

5.80

自引率

2.70%

发文量

期刊介绍： Infectious Agents and Cancer is an open access, peer-reviewed online journal that encompasses all aspects of basic, clinical, epidemiological and translational research providing an insight into the association between chronic infections and cancer. The journal welcomes submissions in the pathogen-related cancer areas and other related topics, in particular: • HPV and anogenital cancers, as well as head and neck cancers; • EBV and Burkitt lymphoma; • HCV/HBV and hepatocellular carcinoma as well as lymphoproliferative diseases; • HHV8 and Kaposi sarcoma; • HTLV and leukemia; • Cancers in Low- and Middle-income countries. The link between infection and cancer has become well established over the past 50 years, and infection-associated cancer contribute up to 16% of cancers in developed countries and 33% in less developed countries. Preventive vaccines have been developed for only two cancer-causing viruses, highlighting both the opportunity to prevent infection-associated cancers by vaccination and the gaps that remain before vaccines can be developed for other cancer-causing agents. These gaps are due to incomplete understanding of the basic biology, natural history, epidemiology of many of the pathogens that cause cancer, the mechanisms they exploit to cause cancer, and how to interrupt progression to cancer in human populations. Early diagnosis or identification of lesions at high risk of progression represent the current most critical research area of the field supported by recent advances in genomics and proteomics technologies.