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.