From the Guidelines
Lamivudine is recommended as an antiviral prophylaxis for the prevention of hepatitis B virus (HBV) reactivation in patients undergoing chemotherapy, but it is not the preferred choice due to its low barrier to resistance, and entecavir or tenofovir are recommended as first-line therapies. The use of lamivudine prophylaxis has been shown to significantly reduce the risk of HBV reactivation, HBV-related hepatitis, and HBV-related mortality in patients receiving cancer chemotherapy 1. However, lamivudine has a low barrier to resistance, and long-term use is limited by the development of resistance, making it less preferred than newer antivirals like entecavir or tenofovir 1.
The current guidelines recommend that antiviral prophylaxis should be started prior to the initiation of immunosuppressive therapy or chemotherapy, and continued for at least 6 months after the completion of chemotherapy, with extension considered according to the chemotherapy risk 1. The choice of antiviral agent should be based on the patient's individual characteristics, such as the presence of cirrhosis, renal function, and the risk of resistance.
Some key points to consider when using lamivudine for HBV prophylaxis in patients undergoing chemotherapy include:
- The standard adult dosage is 100 mg taken orally once daily, with dose adjustments required for patients with renal impairment
- Treatment duration typically ranges from one to several years, depending on the patient's response and HBV e-antigen (HBeAg) status
- Regular monitoring of liver function tests, HBV DNA levels, and renal function is essential during treatment
- Patients should be aware that abrupt discontinuation can lead to severe hepatitis flares, and lamivudine may interact with medications that are eliminated by active organic cationic secretion
- Entecavir or tenofovir are recommended as first-line therapies due to their high barrier to resistance and superior efficacy compared to lamivudine 1.
In summary, while lamivudine can be used as an antiviral prophylaxis for the prevention of HBV reactivation in patients undergoing chemotherapy, its use is limited by its low barrier to resistance, and entecavir or tenofovir are recommended as first-line therapies due to their superior efficacy and safety profile.
From the Research
Role of Lamivudine in HBV Infection Treatment During Chemotherapy
- Lamivudine is a nucleoside analogue and a potent inhibitor of HBV reverse transcription, used to prevent hepatitis B reactivation in patients with cancer who test positive for hepatitis B surface antigen (HBsAg) and are undergoing chemotherapy 2, 3.
- The use of lamivudine as prophylaxis for HBV reactivation in patients with chronic HBV infection or prior infection with recovery has been shown to be effective in reducing the risk of HBV reactivation and HBV-associated morbidity and mortality 3, 4, 5.
- Studies have demonstrated that lamivudine prophylaxis can reduce the relative risk of HBV reactivation, hepatitis, chemotherapy disruptions, and mortality due to HBV reactivation in patients with solid tumors and breast cancer 3, 4, 5.
- Different strategies for using lamivudine, including early preemptive, deferred preemptive, and therapeutic strategies, have been proposed and studied, with early preemptive strategy showing superiority in reducing HBV recurrence, HBV-related hepatitis, and chemotherapy disruption 5, 6.
- The duration of lamivudine use and treatment course may vary depending on the strategy used, with deferred preemptive strategy resulting in shorter duration of lamivudine use during chemotherapy, but similar treatment course once initiated 6.
Key Findings
- Lamivudine is effective in suppressing HBV reactivation and reducing HBV-related morbidity and mortality in patients with cancer who test positive for HBsAg and are undergoing chemotherapy 2, 3, 4, 5.
- Prophylactic use of lamivudine is recommended for patients with chronic HBV infection or prior infection with recovery who are undergoing chemotherapy 2, 3, 4, 5.
- Early preemptive strategy may be superior to therapeutic strategy in reducing HBV recurrence, HBV-related hepatitis, and chemotherapy disruption 5.
- Deferred preemptive strategy may be feasible and effective in controlling HBV replication and preventing its reactivation in breast cancer patients undergoing chemotherapy 6.