Reactivation of hepatitis B virus (HBV) during
chemotherapy is well documented. However, there are limited data on this complication in patients with
hepatocellular carcinoma (HCC) undergoing transarterial
chemotherapy. The aim of this study was to evaluate the efficacy of preemptive
lamivudine therapy in reducing
hepatitis due to HBV reactivation in patients with HCC undergoing transarterial chemo-lipiodolization (TACL) and to seek predictors of this event. A total of 73 consecutive HCC patients undergoing TACL using
epirubicin 50 mg/m2 and
cisplatin 60 mg/m2 at monthly intervals were prospectively and randomly assigned to receive
lamivudine 100 mg daily from the start of TACL (preemptive group) or not (control group). During the study, 11 (29.7%) of 37 patients in the control group and 1 (2.8%) of 36 patients in the preemptive group developed
hepatitis due to HBV reactivation (P = .002). In addition, there were significantly more incidences of overall
hepatitis (P = .021) and severe grade of
hepatitis (P = .035) in the control group. With multivariate Cox regression model, a baseline HBV
DNA level of more than 10(4) copies/mL was the only independent predictor of
hepatitis due to HBV reactivation during chemo-lipiodolization (P = .046). In conclusion, preemptive
lamivudine therapy demonstrated excellent efficacy in reducing
hepatitis due to HBV reactivation and hepatic morbidity during TACL. Preemptive
therapy should be considered in HCC patients with an HBV
DNA level of more than 10(4) copies/mL. Further studies are needed to confirm the value of this approach in patients with low-level
viremia.