Hepatitis B reactivation related to everolimus

Abstract

Reactivation of hepatitis B virus (HBV) during chemotherapy is a well known complication in patients with chronic hepatitis B and cancer. The clinical manifestations range from subclinical elevation of liver enzymes to severe, potentially fatal fulminant hepatitis. Reactivation can occur in a patient with previous inactive HBV infection; either an inactive carrier or a patient with resolved hepatitis. Everolimus is a mammalian target of rapamycin (mTOR) inhibitor approved in renal cell carcinoma, neuroendocrine tumours and breast cancer. mTOR inhibitors are a new generation of drugs for targeted treatment; therefore, little about their side effects is known. Here, we report a patient with renal cell carcinoma who experienced a flare of hepatitis B infection during treatment with everolimus. Clinicians should be aware of HBV reactivation in patients who are undergoing treatment with everolimus, and screening for hepatitis B infection and prophylactic antiviral treatment should be considered.

Keywords: Everolimus; Hepatitis B; Immunosuppressive treatment; Mammalian target of rapamycin inhibitors; Renal cell carcinoma; Virus reactivation.

Figure 1

Serum transaminase (A) and bilirubin (B) levels of the hepatitis B virus reactivation patient. Everolimus treatment was initiated in January, 2012. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; DB: Direct bilirubin; TB: Total bilirubin.