HBV reactivation and hepatitis
During the follow-up period, only two of the 70 patients (2.9%) experienced HBV reactivation. The details of the 2 patients with HBV reactivation are shown in Figure 4. Briefly, both were male and had undetectable baseline HBV DNA levels. Patient 1 received atezolizumab in combination with bevacizumab and developed HBV reactivation at the 2nd visit (after 5 doses of atezolizumab). The patient’s HBV DNA level was 3162.3 IU/mL at diagnosis of HBV reactivation, achieved the highest level at the 3rdvisit (3622.8 IU/ML), but fell to 205.1 IU/mL, <10 IU/mL and undetectable at the 4th, 5th and 6th visit, respectively. The peak ALT level was 68 U/L during the follow-up. Patient 2 received tislelizumab in combination with lenvatinib and developed HBV reactivation at the 2nd visit (after 6 doses of tislelizumab). The patient’s HBV DNA level was 2417 IU/mL at diagnosis of HBV reactivation (the highest level), but fell to 20.2 IU/mL and undetectable at the 4th and 5th visit, respectively, with a peak ALT level of 49 U/L. Accordingly, both patients 1 and 2 exhibited a brief increase in HBV DNA levels without HBV-associated ALT elevation. None of the patients experienced immunotherapy disruption during the follow-up. In addition, 16 of the 70 patients (22.9%) experienced ALT elevation; however, all of these were considered cases of immune-related hepatitis as none of the 16 patients suffered from HBV reactivation.