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Lamivudine prophylaxis for hepatitis B virus carrier patients with breast cancer during adjuvant chemotherapy

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Abstract

Background

This study aimed to assess the efficacy of lamivudine prophylaxis on hepatic complications in HBsAg-positive patients with breast cancer undergoing adjuvant chemotherapy and to describe the temporal trend in HBV surveillance and prophylaxis during the last decade.

Methods

Patients with stage I–III curatively resected invasive breast cancer who received adjuvant and/or neoadjuvant chemotherapy between 2000 and 2009 were eligible for this study. Patients with positive HBsAg and normal liver function were enrolled. Hepatotoxicity, defined as alanine aminotransferase (ALT) ≥100 IU/ml, and HBV reactivation were compared according to lamivudine prophylaxis. Annual trends in HBV surveillance and use of lamivudine prophylaxis were also reviewed.

Results

One hundred sixty-five HBsAg-positive patients with breast cancer were enrolled. After the year 2004, surveillance of HBV infection status and use of lamivudine prophylaxis increased significantly (2.5 vs. 57.6 %, P < 0.001). Seventy-three (44.2 %) patients received lamivudine prophylaxis and 92 (55.8 %) patients did not. The incidence of hepatotoxicity was significantly lower in the group receiving prophylaxis (2.7 vs. 14.1 %, P = 0.011) with fewer premature terminations of planned adjuvant chemotherapy (0 vs. 10.9 %, P = 0.004) in the prophylaxis group. Among the patients for whom the baseline HBV DNA titer was available, the HBV reactivation rate was lower, albeit not significantly, in the prophylaxis group (0 %) compared with the no prophylaxis group (20 %) (P = 0.104). Lamivudine-withdrawal hepatitis was not detected; however, one case of breakthrough HBV reactivation during lamivudine treatment was observed in this study.

Conclusions

Over the past decade, there has been an increase in the awareness of HBV reactivation and in the use of lamivudine during cytotoxic chemotherapy. Lamivudine prophylaxis reduced hepatic complications during adjuvant chemotherapy in patients with breast cancer. Lamivudine prophylaxis should be considered in HBsAg-positive patients with breast cancer who are candidates for adjuvant chemotherapy.

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Acknowledgments

This work was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A040151).

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Authors and Affiliations

  1. Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehang-Ro, Jongno-Gu, Seoul, 110-744, Korea

    Hyun Jung Lee, Bhumsuk Keam, Sae-Won Han, Do-Youn Oh, Tae-You Kim & Seock-Ah Im

  2. Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2 dong, Songpa-Gu, Seoul, 138-736, Korea

    Dae Young Kim

  3. Division of Gastroenterology-Hepatology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehang-Ro, Jongno-Gu, Seoul, 110-744, Korea

    Jeong Hoon Lee & Jung Hwan Yoon

  4. Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea

    Yu Jung Kim, Keun Wook Lee, Jong Seok Lee & Jee Hyun Kim

  5. Division of Gastroenterology-Hepatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea

    Jin-Wook Kim & Sook-Hyang Jeong

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  1. Hyun Jung Lee
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  2. Dae Young Kim
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  3. Bhumsuk Keam
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  8. Tae-You Kim
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  9. Yu Jung Kim
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  10. Keun Wook Lee
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  13. Jong Seok Lee
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  14. Jee Hyun Kim
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  15. Seock-Ah Im
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Corresponding authors

Correspondence to Jee Hyun Kim or Seock-Ah Im.

Additional information

J.H. Kim and S.-A. Im contributed equally to this work.

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Lee, H.J., Kim, D.Y., Keam, B. et al. Lamivudine prophylaxis for hepatitis B virus carrier patients with breast cancer during adjuvant chemotherapy. Breast Cancer 21, 387–393 (2014). https://doi.org/10.1007/s12282-012-0417-3

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  • DOI: https://doi.org/10.1007/s12282-012-0417-3

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