Paul, S., Saxena, A., Terrin, N., Viveiros, K., Balk, E.M., & Wong, J.B. (2016). Hepatitis B virus reactivation and prophylaxis during solid tumor chemotherapy: A systematic review and meta-analysis. Annals of Internal Medicine, 164, 30–40.

DOI Link

Purpose

STUDY PURPOSE: To determine the risk of hepatitis B virus (HBV) reactivation with or without antiviral prophylaxis, and the effectiveness of prophylaxis

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: MEDLINE, Web of Science, Cochrane Collaboration, TOXNET, Scopus
 
INCLUSION CRITERIA: Patients with HBV receiving chemotherapy for any solid tumor; randomized, controlled trials (RCTs) or observational studies including at least five patients per group and a minimum one-month follow-up postchemotherapy
 
EXCLUSION CRITERIA: Pediatric populations; patients with HIV, hepatitis C, and hepatic cancer

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 2,192
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Newcastle Ottawa Scale for observational studies and Cochrane Collaboration assessment for RCTs

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 26
  • TOTAL PATIENTS INCLUDED IN REVIEW: 2,079
  • SAMPLE RANGE ACROSS STUDIES: 6–258 patients
  • KEY SAMPLE CHARACTERISTICS: Included patients with chronic HBV and resolved HBV

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

Risk for HBV reactivation without prophylaxis ranged from 4%–68% (median = 25%) and with prophylaxis ranged from 0.9%–31.4% (median = 4.1%). Among 13 studies comparing reactivation risk between patients who did and did not receive HBV prophylaxis, the pooled odds ratio [OR] was 0.12 (95% confidence interval [CI] [0.06, 0.22]).

Conclusions

HBV prophylaxis can help reduce the odds of HBV reactivation in patients with solid tumors undergoing chemotherapy.

Limitations

  • High heterogeneity among studies prevented an analysis of risk of reactivation in individuals without prophylaxis.
  • Only one RCT
  • Small effect size, although statistically significant

Nursing Implications

HBV prophylaxis may reduce the chance of patients with a history of HBV experiencing reactivation when undergoing chemotherapy for solid tumors. The authors of this article noted that guidelines regarding HBV screening vary. While the American Society of Clinical Oncology (ASCO) recommends screening for individuals at high risk, the Centers for Disease Control and Prevention (CDC) and others recommend screening all patients receiving immunosuppressive therapy. The findings here provide some support for broad HBV screening and the appropriate use of HBV prophylaxis; however, this analysis had multiple limitations. Further study is warranted to determine the screening, prophylaxis, and cost-effectiveness benefits of these actions.

Legacy ID

6056