拉米夫定联合TACE治疗原发性肝癌合并肝硬化30例

Reactivation of hepatitis B virus and antiviral treatment in cancer patients receiving chemotherapy

AIM: To investigate the reactivation of hepatitis B virus (HBV) and the effect of antiviral treatment in cancer patients receiving chemotherapy.

METHODS: Clinical data for 2 253 cancer patients undergoing chemotherapy were reviewed. Of 125 patients who were positive for HBV surface antigen, 37 received antiviral treatment (therapy group) and 88 did not (control group). These patients were followed for at least 6 mo after the completion of treatment. During the course of chemotherapy, liver function tests, viral load (HBV-DNA), and HBV reactivation rate were determined on days 1 and 10 of each cycle.

RESULTS: A total of 879 (39.0%) cancer patients were screened for HBV status. In 125 patients who were positive for HBV surface antigen, 47 (37.6%) developed hepatitis during chemotherapy. Of these 47 patients, 7 (18.9%) were included in the antiviral treatment group and 40 (45.5%) in the control group (P = 0.008). Two patients in the antiviral treatment group developed severe hepatitis [2 (5.4%) vs 19 (21.6%), P = 0.035]. In the antiviral treatment group, there was significantly less patients developing HBV reactivation [1 (2.7%) vs 16 (18.2%), P = 0.022] or discontinuing chemotherapy (8.1% vs 33.0%, P = 0.003).

CONCLUSION: Prophylactic antiviral treatment significantly reduces the incidence of HBV reactivation in cancer patients undergoing chemotherapy.

Lamivudine with or without adefovir dipivoxil for postoperative hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) is a significant cause of death, especially in Asia and sub-Saharan Africa. Removal of the cancer through surgery or other techniques is considered the first-line therapy in early HCC, but relapse of HCC is the main postoperative problem. The main risk factor for HCC is hepatitis B virus (HBV) infection. Lamivudine and adefovir dipivoxil are effective and tolerable for chronic hepatitis B by suppressing the viral load and to reduce fibrosis in the liver.  

OBJECTIVES

To assess the benefits and harms of postoperative administration of lamivudine with or without adefovir dipivoxil in participants with surgically treated HCC and chronic HBV infection or HBV carrier state.

SEARCH METHODS

A systematic search was performed in The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded (SCI Exp) in October 2011. Further trials have been sought through scanning reference lists of relevant articles.

SELECTION CRITERIA

Randomised clinical trials comparing the administration of lamivudine with and without adefovir dipivoxil for participants with ablation treated HCC (surgical or through other techniques) and chronic HBV infection or HBV carrier state, regardless of publication status, language, blinding, and publication status, were to be included in this review. We planned to extract data on harms from quasi-randomised studies or cohort studies when retrieved with the search results.

DATA COLLECTION AND ANALYSIS

Two authors independently selected studies for inclusion, and extracted and analysed the data. The type and number of adverse events were reported descriptively.

MAIN RESULTS

No randomised trials could be included into this systematic review. Thus, we were unable to follow our pre-published protocol and perform meta-analyses.Through our searches for randomised clinical trials, four cohort trials with 230 participants were retrieved. We read them in order to find data on harm, ie, adverse events. Breakthrough hepatitis was a serious adverse event attributable to lamivudine. No other adverse events seemed to be caused by the administration of lamivudine or adefovir dipivoxil were reported in the four cohort studies.

AUTHORS' CONCLUSIONS

No evidence from randomised trials on the beneficial or harmful effects of lamivudine with or without adefovir dipivoxil for postoperative HCC was found. Randomised clinical trials with large number of participants and long follow-up period should be carried out to direct clinical practice.