Liu, J.Y., Sheng, Y.J., Ding, X.C., Tang, H., Tong, S.W., Zhang, D.Z., . . . Hu, H.D. (2015). The efficacy of lamivudine prophylaxis against hepatitis B reactivation in breast cancer patients undergoing chemotherapy: A meta-analysis. Journal of the Formosan Medical Association, 114, 164-173.

STUDY PURPOSE: Evaluate the efficacy of lamivudine prophylaxis  (100 mg daily) on HBsAg seropositive patients with breast cancer undergoing chemotherapy.

TYPE OF STUDY: Meta analysis and systematic review

DATABASES USED: Medline, Embase, and the Cochrane databases

INCLUSION CRITERIA: (a) Types of studies: randomized controlled cohort, retrospective comparative case series, and prospective, controlled, non-randomized studies; (b) studies that included a lamivudine prophylaxis group and a group that did not receive lamivudine prophylaxis; and (c) all patients received chemotherapy and were HBsAg sero-positive.

EXCLUSION CRITERIA: Patient populations were excluded if: (a) the study did not measure HBV reactivation/flare as a specific outcome; (b) the patients did not receive chemotherapy; (c) patients had HIV co-infection; (d) patients had hepatitis D virus, hepatitis C virus, or other liver diseases; (e) there was no lamivudine prophylaxis and non-prophylaxis group; and (f) there was insufficient analytic information available.

TOTAL REFERENCES RETRIEVED: 16

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Two independent reviewers retrieved and evaluated studies using a validated tool for scoring the quality of the study. Meta-analysis was performed using Review Manager Software 5.0.

• FINAL NUMBER STUDIES INCLUDED: 6 
• TOTAL PATIENTS INCLUDED IN REVIEW: 499
• SAMPLE RANGE ACROSS STUDIES: 20-169
• KEY SAMPLE CHARACTERISTICS: Sample consisted of  Asian female patients with breast cancer who were hepatitis HBsAg seropositive and treated with 4-6 cycles of chemotherapy (AC, AC + T, or CAF).

PHASE OF CARE: Active anti-tumor treatment

Lamivudine prophylaxis significantly reduced the risk of HBV reactivation in HBsAg seropositive patients (RR = 0.23, 95% CI [0.13, 0.39], p < 0.00001); the risk of hepatitis (RR = 0.2, 95% CI [0.08, 0.47], p =0.002); the rate of overall chemotherapy disruptions (RR = 0.36, 95% CI [0.21, 0.64], p = 0.0004); and the rate of delay of eight days or greater between cycles in those patients who completed chemotherapy (RR = 0.42, 95% CI [0.21, 0.82], p = 0.01).

Lamivudine 100 mg daily used as prophylaxis for HBsAg-seropositive patients undergoing chemotherapy significantly reduces the risk of hepatitis B reactivation and prevents chemotherapy delays.

• Limited number of studies included
• Exclusively Asian population, which is a population that has a high prevalence of hepatitis B carriers
• Only 1 of the 6 studies was a RCT.

Lamivudine 100 mg daily is recommend to prevent hepatitis B reactivation in patients who are HbsAg seropositive. There is no consensus on timing and duration of lamivudine prophylaxis. Some experts recommend lamivudine should be started at least one week before initiation and be continued until at least six weeks after the chemotherapy.