Hepatitis B virus reactivation in patients with solid tumors receiving systemic anticancer treatment

Ann Oncol. 2016 Dec;27(12):2172-2184. doi: 10.1093/annonc/mdw414. Epub 2016 Nov 1.


Background: Hepatitis B virus (HBV) reactivation is a well-known risk during chemotherapy for hematological malignancies with reported rates ranging between 14% and 72%. However, there is a paucity of data regarding HBV infection management and reactivation risk in patients receiving systemic treatments for solid tumors.

Design: We conducted a PubMed search for publications from January 1990 until May 2016 related to HBV reactivation. The search terms were 'hepatitis B reactivation', cross-referenced with 'chemotherapy', then 'hepatitis B' cross-referenced with International Non-proprietary Name of each of the most used chemotherapy drugs in solid tumors.

Results: From these data, a grading of HBV reactivation risk and recommendations for management are given for most frequently used anticancer drugs in solid tumors.

Conclusion: Most drugs used for the treatment of solid tumors can induce hepatitis B reactivation in HBs antigen-positive patients. HBV screening can be recommended before systemic treatment initiation. Pre-emptive antiviral treatment can reduce the risk of HBV reactivation and prevent chemotherapy disruption.

Keywords: chemotherapy; hepatitis B reactivation; immunotherapy; monoclonal antibodies; solid tumors; tyrosine kinase inhibitors.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Doxorubicin / adverse effects
  • Hepatitis B / chemically induced
  • Hepatitis B / pathology*
  • Hepatitis B / virology
  • Hepatitis B virus / drug effects*
  • Hepatitis B virus / genetics
  • Hepatitis B virus / pathogenicity
  • Humans
  • Neoplasms / complications
  • Neoplasms / drug therapy*
  • Neoplasms / virology
  • Rituximab / adverse effects
  • Virus Activation / drug effects


  • Antineoplastic Agents
  • Rituximab
  • Doxorubicin