Entecavir May Be Superior in Lowering HBV-related Hepatitis Incidence in Lymphoma
Recent results on entecavir may change use of lamivudine prophylaxis in cancer patients with the hepatitis B virus.
In patients seropositive for hepatitis B surface antigen with diffuse large B-cell lymphoma undergoing chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), receiving the antiviral drug entecavir appears to result in a lower incidence of hepatitis B virus (HBV)-related hepatitis and HBV reactivation compared with the antiviral drug lamivudine.
Research recently reported in the Journal of the American Medical Association indicates that the rates for hepatitis B were significantly lower for patients receiving entecavir compared with lamivudine-treated patients.1
“Hepatitis B virus reactivation is a well-documented chemotherapy complication, which can lead to chemotherapy delay or premature termination and can jeopardize malignancy outcomes,” said study investigator Tongyu Lin, MD, PhD, of the Sun Yat-sen University Cancer Center in Guangzhou, China.
“This is the first prospective, randomized study comparing entecavir and lamivudine for prevention of HBV reactivation in [patients with] cancer. The incidence of HBV-associated hepatitis was significantly decreased in the entecavir group as was HBV reactivation.”
Dr. Lin and his colleagues randomly assigned 121 patients that were seropositive for the hepatitis B surface antigen with untreated diffuse large B-cell lymphoma to receive either entecavir (61 patients) or lamivudine (60 patients). The patients began etecavir or lamivudine treatment 1 week prior to the initiation of R-CHOP through 6 months after completion of chemotherapy.
The open-label, phase 3 study was conducted at 10 medical centers in China from February 2008 through December 2012. This investigation was part of a substudy of a parent study that compared a 3-week and 2-week R-CHOP chemotherapy regimen.
The research indicated that HBV-related-hepatitis occurred in 0% of patients in the entecavir group compared to 13.3% for the lamivudine group. The HBV reactivation was 6.6% for the entecavir group compared to 30% for the lamivudine group, and delayed hepatitis B occurred in 0% in the entecavir group compared to 8.3% for the lamivudine group.