Safety and efficacy of immune checkpoint inhibitors in patients with cancer and hepatitis B: multicentre experience in a low-middle-income country

BACKGROUND: Immune checkpoint inhibitors (ICIs) are widely used in clinical practice. The primary objective of this study is to evaluate the safety and efficacy of ICIs in patients diagnosed with cancer who also have chronic hepatitis B virus (HBV) infection. METHODS: We reviewed the charts of patients who received an ICI between 2016 and 2023 at three tertiary cancer centers. We included those who had known chronic HBV infection. RESULTS: Of the 1352 patients screened, we identified 65 (4.8%) with concurrent hepatitis B. Of the 65 patients, 8 (12.3%) experienced irAEs (immune-related adverse events) of any grade, with 1 (1.5%) having grade 3 pneumonitis. No cases of reactivation were seen except for one patient (1.5%) with poor compliance with his antiviral drug developed hepatitis B reactivation 9 months after discontinuation of ICI. CONCLUSION: ICIs appear safe in patients with chronic hepatitis B, especially when antiviral treatment is given. We believe these patients should not be deprived of the potential benefits of ICIs solely because of chronic viral infection, neither in daily practice nor in clinical trials.