What's Best for Averting HBV Reactivation?

One of the major advances in the management of diffuse large B-cell lymphoma has been the addition of the anti-CD20 monoclonal antibody rituximab to the chemotherapy regimen of cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, the increased immunosuppression associated with this new combination regimen greatly increases the risk for reactivation of hepatitis B virus (HBV) disease in patients seropositive for HBV surface antigen. In a recent multicenter, randomized, phase III trial, researchers compared entecavir (0.5 mg daily) with lamivudine (100 mg daily) for efficacy in preventing this complication.

Conducted between February 2008 and December 2012, this open-label trial involved 121 HBV surface antigen–positive adults in China who were starting R-CHOP for diffuse B-cell lymphoma. The antiviral agents were given from 1 week before initiation until 6 months after completion of chemotherapy. Analyses were intent-to-treat.

The incidence of HBV reactivation was lower in the entecavir group than in the lamivudine group (6.6% vs 30%; P=0.001); the incidence of HBV-related hepatitis was also lower in the entecavir group (0% vs. 13.3%; P=0.003). Hepatitis overall, delayed HBV-related hepatitis, and chemotherapy disruptions all occurred significantly less often in the entecavir group.