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Authors' reply: Current strategies in the management of hepatitis B virus reactivation

Nature Reviews Clinical Oncology volume 9, page 350 (2012)Cite this article

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We would like to thank Xing Li, Yan-Fang Xing, Qu Lin, Min Dong, Xiang-Bo Wan and Xiang-Yuan Wu for their correspondence on our Review (Reactivation of hepatitis B virus and hepatitis C virus in patients with cancer. Nat. Rev. Clin. Oncol. 9, 156–166; 2012),1 which raises some important issues (The treatment of severe hepatitis B virus reactivation after chemotherapy. Nat. Rev. Clin. Oncol. doi:10.1038/nrclinonc.2012.1-c1).2 Their comments highlight some of our own concerns regarding the treatment of hepatitis B virus (HBV) reactivation. We agree that our Review focused primarily on prevention of HBV reactivation. Although rescue treatment for acute HBV reactivation is an important issue, its description was beyond the scope of our Review, which was written for an oncology audience. We sought to provide oncologists with information to improve the understanding of HBV (and hepatitis C virus) reactivation, with the hopes of lowering the risk of hepatic complications and improving the overall survival for patients with cancer. In our opinion, data on salvage therapy is better suited to journals focusing on hepatology or infectious diseases.

In their correspondence, Li et al.2 referred to their series of 19 patients with lymphoma who were diagnosed and treated for hepatitis exacerbation following treatment with chemotherapy in combination with rituximab.3 Not all patients in the study had hepatitis attributed to HBV reactivation. Five of the 19 patients had serum HBV DNA tests before each cycle of chemotherapy and received prophylactic lamivudine; these patients reached viral response. Two patients who had viral breakthroughs with lamivudine-induced YMDD mutations continued to receive prophylactic lamivudine and subsequently died of acute HBV exacerbation. Rescue antiviral strategies (monotherapy or combination therapy) did not influence the outcomes of these patients, probably because of delays in the initiation of antiviral therapy. However, rescue treatment shortened viral response times and seemed to improve the prognosis of patients with acute exacerbation of HBV. There is no mention in the manuscript on the type of salvage agents used to suppress viraemia.3

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Authors and Affiliations

  1. Department of Infectious Diseases, Infection Control and Employee Health, Unit 1460, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, 77030, TX, USA

    Harrys A. Torres

  2. Department of Gastroenterology, Hepatology and Nutrition, Unit 1466, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, 77030, TX, USA

    Marta Davila

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Correspondence to Harrys A. Torres.

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Competing interests

H. A. Torres declares that he has acted as a consultant for Merck and Vertex. M. Davila declares no competing interests.

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Torres, H., Davila, M. Authors' reply: Current strategies in the management of hepatitis B virus reactivation. Nat Rev Clin Oncol 9, 350 (2012). https://doi.org/10.1038/nrclinonc.2012.1-c2

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