Hepatitis B reactivation in cancer patients receiving immune checkpoint inhibitors: a systematic review and meta-analysis

Background Immunotherapy shows promise as a treatment option for various cancers. However, there is growing concern over potential complications from hepatitis B virus (HBV) reactivation after checkpoint blockade immunotherapy. Although most of the previous clinical trials on immune checkpoint inhib...

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Bibliographic Details
Published in:Infectious diseases of poverty 2023-09, Vol.12 (1), p.1-87, Article 87
Main Authors: Xia, Zhengzheng, Zhang, Jianyu, Chen, Wenjun, Zhou, Haiyan, Du, Di, Zhu, Kongcai, Chen, Hui, Meng, Jun, Yang, Jun
Format: Article
Language:English
Subjects:
Analysis
Antigens
Antiviral agents
Cancer
Cancer patients
Cell death
Developing countries
Drug therapy
Health aspects
Hepatitis
Hepatitis B
Hepatitis B virus reactivation
Immune checkpoint inhibitors
Immunotherapy
Infections
Inhibitors
LDCs
Meta-analysis
Oncology, Experimental
Patients
Prophylaxis
Risk assessment
Safety
Scoping Review
Systematic review
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Summary:Background Immunotherapy shows promise as a treatment option for various cancers. However, there is growing concern over potential complications from hepatitis B virus (HBV) reactivation after checkpoint blockade immunotherapy. Although most of the previous clinical trials on immune checkpoint inhibitors (ICIs) excluded patients with HBV, a few case reports and retrospective studies of HBV reactivation have been published. The aim of this study is to assess the risk of hepatitis B virus reactivation (HBVr) in patients receiving ICIs for advanced cancer. Methods English and Chinese language literature published prior to April 30, 2023, was searched in PubMed, EMBASE, Web of Science, Cochrane, SinoMed, CNKI and Wanfang Data for studies reporting HBVr rates in cancer patients treated with ICIs. A pooled risk estimate was calculated for HBVr rates with 95% confidence intervals (CI). Results Data from 34 studies including 7126 patients were retrieved and analyzed. The pooled HBVr rate in cancer patients treated with ICIs was 1.3% (I.sup.2 = 90.44%, 95% CI: 0.2-2.9%, P < 0.001). Subgroup analysis revealed that patients diagnosed with hepatocellular carcinoma (HCC), HBV carriers, and patients from Asian regions or in developing countries have a higher rate of HBVr. Conclusions Our meta-analysis demonstrated a low risk of HBVr in patients treated with ICIs for advanced cancer. ICI treatment may be safely used in patients with existing HBV infection or chronic hepatitis B, accompanied by regular monitoring and appropriate antiviral prophylaxis if necessary. Graphical Keywords: Hepatitis B virus reactivation, Immune checkpoint inhibitors, Cancer, Systematic review, Meta-analysis, Safety
ISSN:2049-9957
2095-5162
2049-9957
DOI:10.1186/s40249-023-01128-6