HBV reactivation risk ‘moderate to high’ for EGFR–TKI-treated NSCLC
medwireNews: Patients with non-small-cell lung cancer (NSCLC) undergoing treatment with an EGFR–tyrosine kinase inhibitor (TKI) may have a clinically meaningful risk for reactivation of unresolved hepatitis B virus (HBV) infection during treatment, study findings indicate.
Therefore, “[c]lose monitoring of hepatic enzymes and HBV viral load may be needed in patients with HBV infection receiving EGFR TKIs,” say Wei-Yu Liao and colleagues from National Taiwan University College of Medicine in Taipei.
During a median 26.2 months of follow-up, 16 (9.6%) of 171 hepatitis B surface antigen (HBsAg)-positive patients with NSCLC experienced HBV reactivation during at least 2 weeks of treatment with an EGFR–TKI (mean treatment duration, 10.5 months),
Reactivation was defined as a 10-fold or greater increase in HBV DNA relative to baseline or an absolute increase to above 105 IU/mL with abnormal liver function for those with normal baseline liver function and no baseline HBV viral load data.
The most commonly used EGFR–TKI was gefitinib (n=95), followed by erlotinib (n=79), afatinib (n=47), and osimertinib (n=17), report Liao and co-authors in the European Journal of Cancer.
The reactivation rate was highest during osimertinib treatment at 17.6%, followed by erlotinib (7.6%), gefitinib (5.3%), and afatinib (4.3%), but the researchers note that the numbers were small and the differences between the groups were not statistically significant.
Reactivation occurred a median 5.6 months after initiation of EGFR–TKI therapy, and the annual incidence rate was 7.9%.
Median overall survival was 44.5 months among the patients with HBV reactivation and did not differ significantly from the median 26.2 months achieved by the patients without HBV reactivation; there were no deaths attributed to HBV reactivation.
Furthermore, there were no significant differences in baseline and treatment characteristics between the patients who did and did not experience reactivation, including age, sex, EGFR mutation status, liver function, liver metastasis, prior chemotherapy, anti-HBV therapy before TKI treatment, and EGFR–TKI duration.
Liao and team conclude that their study “reminds us that use of EGFR TKIs may carry a moderate to high risk of HBV reactivation.”
They add their results are “especially important for patients in Asia,” because of the high prevalence of HBV infection in that region and the fact that more than half of patients with NSCLC harbour EGFR mutations.
The researchers also point out that further work is needed to determine whether EGFR–TKI treatment increases the risk for HBV reactivation among patients with resolved HBV infection.
By Laura Cowen
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