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Incidence of hepatitis B virus reactivation in breast cancer patients undergoing cytotoxic chemotherapy
Category 6: Viral hepatitis: clinical aspects of LAM in anti-HBe-positive chronic hepatitis B, but the high LAMresistant mutant rate and the dubious treatment benefit after YMDD mutant selection indicates that continuous LAM monotherapy should be re-evaluated.
-1 INCIDENCE OF HEPATITIS B VIRUS REACTIVATION IN BREAST CANCER PATIENTS UNDERGOING CYTOTOXlC CHEMOTHERAPY W. Yet, P.K.S. Chan 1, p. Hui, Wing M. Ho, W.H. Kwan, S. Zhong, P.J. Johnson. Depts of Clinical Oncology; 1Microbiology, Chinese University of Hung Kong, Prince of Wales Hospital, Hung Kong, China Background: Cancer patients who are chronic carders of hepatitis B virus (HBV) have a higher hepatic complication rate while receiving cytotoxic chemotherapy (CT), and this has mainly been attributed to HBV reactivation. However, reported studies have mainly focused on patients with lymphoma. With the increasing use of adjuvant CT in breast cancer, and the high prevalence of HBV infection in Asia, it is important to determine the HBV-related morbidity associated with the use of CT in this group of patients. Methods: In this study, breast cancer patients who were planned for CT had their hepatitis B surface antigen (HBsAg) status determined. Those found to be HBsAg seropositive were prospectively followed up during their course of treatment with monitoring of liver function and HBV DNA. The objectives are: [1] to determine the rate of hepatic complications during CT in relation to HBV reactivation; [2] to identify associated risk factors. Results: Over an 18-month period, there were 32 HBsAg seropositive breast cancer patients. During CT, 20 developed hepatitis (62.5%), amongst whom 11 (55%) were attributable to HBV reactivation. Age, HBeAg status, presence of malignant hepatic infiltration, pre-chemotherapy ALT and HBV-DNA levels, the type of CT and the use of corticosteroids were not found to be significantly different between the patients who did and did not develop HBV reactivation. Conclusions: Despite previous reports focusing on high incidence of HBV reactivation in patients with lymphoid malignancies, the present study highlights the importance of monitoring HBsAg seropositive patients who are receiving CT for common solid tumours such as breast cancer. No associated risk factors could be identified with this condition.
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DO WOMEN WHO DEVELOP AN IATROGENIC CHRONIC HEPATITIS C VIRUS (HCV) INFECTION IN A HEALTH CARE SERVICE DIFFER IN THEIR PSYCHOLOGICAL WELL-BEING, QUALITY OF LIFE AND HEALTH BELIEFS/FEELINGS FROM WOMEN WITH A GENETIC LIVER DISORDER KNOWN AS HAEMOCHROMATOSlS?
Barbara Coughlan, John Sheehan, AnneMarie Flanagan, Eleanor Ryan, Alan Can', John Crowe. Center for Liver Disease, Institution: Mater Misericordiae Hospital, Dublin, Ireland Aim: The aim of this study was compare psychosocial well-being in a group of women with an iatrogenic chronic HCV infection and a group of women with haemochromatosis. Methodology: 39 women with an iatrogenic chronic HCV and 36 women with haemochromatosis. Health outcomes in both groups were assessed by a Study Specific Questionnaire, the Sf-36 scale (Jenkinson & Coulter 1993) and the GHQ30 (Goldberg, 1988). A series of MannWhitney tests comparing both groups on quality of life revealed that those with chronic HCV infection differed on all eight SF-36 dimensions; physical functioning (Z = -4.7, p < 0.05); social functioning (Z = -5.5, p < 0.05); role limitations due to physical problems (Z = -5.2, p < 0.05); role limitations due to emotional problems (Z = -3.8, p < 0.05); general mental health (Z = -3.9, p < 0.05); energy/vitality (Z = -4.1, p < 0.05); bodily pain (Z = -4.9, p < 0.05) and general
133
health perceptions (Z = -5.8, p < 0.05). Both groups also differed in psychological well-being (Z = -5.13, p > 0.05). A series of t-tests comparing both groups on their beliefs and feelings regarding their illness revealed that women with chronic HCV infection reported; more negative feelings regarding their illness (t = -6.89, p < 0.05); more problems working in/outside their homes (t = -8.9, p < 0.01); more relationship (t = -2.46, p < 0.05) and emotional problems with their family (t = -7.5, p < 0.01) and a decrease in sexual activity (t = -4.3, p < 0.01) since their illness than women with haemochromatosis. Conclusions: A diagnosis of an iatrogenic chronic HCV infection is perceived as psychologically distressing, physically challenging and more interfering to personal and family life than a diagnosis of haemochromatosis.
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META-ANALYSIS OF THYMOSIN-A1 TREATMENT IN CHRONIC HEPATITIS B VIRUS (HBV) INFECTION
H. Chan. Hung Kong, China Objective: We aimed to review the efficacy of thymosin-~ 1 in chronic HBV infection by a meta-analysis of the published data. Methods: Randomized controlled trials on thymosin-a 1 treatment of chronic HBV infection with 6 month post-treatment follow-up were searched from electronic databases. Intent-to-treat analysis and fixed effect model were used in all analyses. Virological response (VR) was defined as disappearance of HBV DNA by non-PCR assays (plus e-seroconversion in HBeAg positive patients), and biochemical response (BR) as normalization of transaminase levels. Results: 5 trials (2 trials with 2 treatment arms) were identified comparig thymosin-al vs placebo and 2 trials comparing thymosin-otl vs interferon. There was no difference between thymosin-t~ 1 and placebo in terms of VR (odds ration 1.19: 95% CI 0.24-4.20) and BR (odds ration 1.10: 95% CI 0.52-2.32) at the end-of-treatment. Thymosin-t~l has a significantly higher VR 6 months post-treatment (odds ratio 2.87: 95% CI 1.58-5.22) but the difference in BR was insignificant (odds rato 1.32: 95% CI 0.70-2.49). There was no difference between the VR and BR of thymosin-t~ 1 and interferon 6 months post=treatment. Conclusion: Thymosin-~l is effective in suppressing HBV DNA in chronic HBV infected patients but the effect is delayed.
] HIGH SUSTAINED RESPONSE RATE AFTER RIBAVIRIN + IFN RETREATMENT OF PATIENTS (PTS) WHO HAVE FAILED A PREVIOUS COURSE OF IFN WITH OR WITHOUT AMANTADINE A. Mangia, N. Minerva 3, M. Annese a, V. Carretta 5, D. Bacca 6, M.R. Villani, F. Perri, A. Giangaspero 2, M. Cela 1, G. Dell'Erba 7, A. Andriulli. Gastroenterology San Giovanni R, 1 Foggia; 2 Bari; 3 Medicine Canosa; 4 Matera; 5 Venosa; 6 Casarano; 7 Taranto, Italy Background: retreatment of pts with Chronic Hepatitis C non responders (NR) to a first course of IFN is currently not recommended. No data are available for those who have failed a previous course of IFN and amantadine (AMA). Methods: all (n = 184) NR pts who have been included, at our Institution, in two randomized clinical trials of IFN, (6 MU tiw for 12 months) alone (n = 133, Group A) or combined with AMA (200 mg daily) (n = 51, Group B), were offered retreatment with IFN (6 MU tiw) combined with ribavirin (1000-1200 rag/die) for 12 months. 74 pts (55.6%) from Group A and 39 (76.4%) from Group B agreed to be retreated, whereas 27 pts (69%) from Group A and 46 (62.1%) from Group B were infected with genotype lb. Factors predictive of response were investigated in all pts with logistic regression analysis. Results: out of 113 pts, 99 are currently evaluable, the remaining ones are still under treatment. Baseline features in NR pts and in those with a SR after retreatment are given in the table.
-1 INCIDENCE OF HEPATITIS B VIRUS REACTIVATION IN BREAST CANCER PATIENTS UNDERGOING CYTOTOXlC CHEMOTHERAPY W. Yet, P.K.S. Chan 1, p. Hui, Wing M. Ho, W.H. Kwan, S. Zhong, P.J. Johnson. Depts of Clinical Oncology; 1Microbiology, Chinese University of Hung Kong, Prince of Wales Hospital, Hung Kong, China Background: Cancer patients who are chronic carders of hepatitis B virus (HBV) have a higher hepatic complication rate while receiving cytotoxic chemotherapy (CT), and this has mainly been attributed to HBV reactivation. However, reported studies have mainly focused on patients with lymphoma. With the increasing use of adjuvant CT in breast cancer, and the high prevalence of HBV infection in Asia, it is important to determine the HBV-related morbidity associated with the use of CT in this group of patients. Methods: In this study, breast cancer patients who were planned for CT had their hepatitis B surface antigen (HBsAg) status determined. Those found to be HBsAg seropositive were prospectively followed up during their course of treatment with monitoring of liver function and HBV DNA. The objectives are: [1] to determine the rate of hepatic complications during CT in relation to HBV reactivation; [2] to identify associated risk factors. Results: Over an 18-month period, there were 32 HBsAg seropositive breast cancer patients. During CT, 20 developed hepatitis (62.5%), amongst whom 11 (55%) were attributable to HBV reactivation. Age, HBeAg status, presence of malignant hepatic infiltration, pre-chemotherapy ALT and HBV-DNA levels, the type of CT and the use of corticosteroids were not found to be significantly different between the patients who did and did not develop HBV reactivation. Conclusions: Despite previous reports focusing on high incidence of HBV reactivation in patients with lymphoid malignancies, the present study highlights the importance of monitoring HBsAg seropositive patients who are receiving CT for common solid tumours such as breast cancer. No associated risk factors could be identified with this condition.
~
DO WOMEN WHO DEVELOP AN IATROGENIC CHRONIC HEPATITIS C VIRUS (HCV) INFECTION IN A HEALTH CARE SERVICE DIFFER IN THEIR PSYCHOLOGICAL WELL-BEING, QUALITY OF LIFE AND HEALTH BELIEFS/FEELINGS FROM WOMEN WITH A GENETIC LIVER DISORDER KNOWN AS HAEMOCHROMATOSlS?
Barbara Coughlan, John Sheehan, AnneMarie Flanagan, Eleanor Ryan, Alan Can', John Crowe. Center for Liver Disease, Institution: Mater Misericordiae Hospital, Dublin, Ireland Aim: The aim of this study was compare psychosocial well-being in a group of women with an iatrogenic chronic HCV infection and a group of women with haemochromatosis. Methodology: 39 women with an iatrogenic chronic HCV and 36 women with haemochromatosis. Health outcomes in both groups were assessed by a Study Specific Questionnaire, the Sf-36 scale (Jenkinson & Coulter 1993) and the GHQ30 (Goldberg, 1988). A series of MannWhitney tests comparing both groups on quality of life revealed that those with chronic HCV infection differed on all eight SF-36 dimensions; physical functioning (Z = -4.7, p < 0.05); social functioning (Z = -5.5, p < 0.05); role limitations due to physical problems (Z = -5.2, p < 0.05); role limitations due to emotional problems (Z = -3.8, p < 0.05); general mental health (Z = -3.9, p < 0.05); energy/vitality (Z = -4.1, p < 0.05); bodily pain (Z = -4.9, p < 0.05) and general
133
health perceptions (Z = -5.8, p < 0.05). Both groups also differed in psychological well-being (Z = -5.13, p > 0.05). A series of t-tests comparing both groups on their beliefs and feelings regarding their illness revealed that women with chronic HCV infection reported; more negative feelings regarding their illness (t = -6.89, p < 0.05); more problems working in/outside their homes (t = -8.9, p < 0.01); more relationship (t = -2.46, p < 0.05) and emotional problems with their family (t = -7.5, p < 0.01) and a decrease in sexual activity (t = -4.3, p < 0.01) since their illness than women with haemochromatosis. Conclusions: A diagnosis of an iatrogenic chronic HCV infection is perceived as psychologically distressing, physically challenging and more interfering to personal and family life than a diagnosis of haemochromatosis.
~-~A
META-ANALYSIS OF THYMOSIN-A1 TREATMENT IN CHRONIC HEPATITIS B VIRUS (HBV) INFECTION
H. Chan. Hung Kong, China Objective: We aimed to review the efficacy of thymosin-~ 1 in chronic HBV infection by a meta-analysis of the published data. Methods: Randomized controlled trials on thymosin-a 1 treatment of chronic HBV infection with 6 month post-treatment follow-up were searched from electronic databases. Intent-to-treat analysis and fixed effect model were used in all analyses. Virological response (VR) was defined as disappearance of HBV DNA by non-PCR assays (plus e-seroconversion in HBeAg positive patients), and biochemical response (BR) as normalization of transaminase levels. Results: 5 trials (2 trials with 2 treatment arms) were identified comparig thymosin-al vs placebo and 2 trials comparing thymosin-otl vs interferon. There was no difference between thymosin-t~ 1 and placebo in terms of VR (odds ration 1.19: 95% CI 0.24-4.20) and BR (odds ration 1.10: 95% CI 0.52-2.32) at the end-of-treatment. Thymosin-t~l has a significantly higher VR 6 months post-treatment (odds ratio 2.87: 95% CI 1.58-5.22) but the difference in BR was insignificant (odds rato 1.32: 95% CI 0.70-2.49). There was no difference between the VR and BR of thymosin-t~ 1 and interferon 6 months post=treatment. Conclusion: Thymosin-~l is effective in suppressing HBV DNA in chronic HBV infected patients but the effect is delayed.
] HIGH SUSTAINED RESPONSE RATE AFTER RIBAVIRIN + IFN RETREATMENT OF PATIENTS (PTS) WHO HAVE FAILED A PREVIOUS COURSE OF IFN WITH OR WITHOUT AMANTADINE A. Mangia, N. Minerva 3, M. Annese a, V. Carretta 5, D. Bacca 6, M.R. Villani, F. Perri, A. Giangaspero 2, M. Cela 1, G. Dell'Erba 7, A. Andriulli. Gastroenterology San Giovanni R, 1 Foggia; 2 Bari; 3 Medicine Canosa; 4 Matera; 5 Venosa; 6 Casarano; 7 Taranto, Italy Background: retreatment of pts with Chronic Hepatitis C non responders (NR) to a first course of IFN is currently not recommended. No data are available for those who have failed a previous course of IFN and amantadine (AMA). Methods: all (n = 184) NR pts who have been included, at our Institution, in two randomized clinical trials of IFN, (6 MU tiw for 12 months) alone (n = 133, Group A) or combined with AMA (200 mg daily) (n = 51, Group B), were offered retreatment with IFN (6 MU tiw) combined with ribavirin (1000-1200 rag/die) for 12 months. 74 pts (55.6%) from Group A and 39 (76.4%) from Group B agreed to be retreated, whereas 27 pts (69%) from Group A and 46 (62.1%) from Group B were infected with genotype lb. Factors predictive of response were investigated in all pts with logistic regression analysis. Results: out of 113 pts, 99 are currently evaluable, the remaining ones are still under treatment. Baseline features in NR pts and in those with a SR after retreatment are given in the table.