Cancer Patient is Killed by Latent Viral Infection During Treatment

This case involves an elderly woman with history of a viral disease of her liver who was undergoing treatment for advanced cancer. She was started on medication that would impact her immune system and her oncologist, who was aware of her history of viral liver disease, ordered a liver function test. The oncologist decided to just monitor the patient, who had slightly elevated liver function test. Over the next several months, despite uptrending LFTs, no interventions were taken. The patient continued to undergo chemotherapy, and eventually died from liver failure associated with her viral infection.

Question(s) For Expert Witness

1. How often do you treat patients with this drug?

2. Have you ever done research or published on this drug and its side effects?

3. What is the standard of care when there is an increase in LFTs in a patient like this?

Expert Witness Response E-034164

I specialized in low-grade B cell neoplasms (Non-Hodgkin's lymphoma) and essentially every treatment regimen I used incorporated this drug. In fact, my main research interest first at Memorial Sloan Kettering and then at Thomas Jefferson was developing chemo-immunotherapy combinations to treat such cancers. As such I published several papers in major journals where this drug was added to chemotherapy. These reports included both efficacy of the regimens as well as toxicities. Given my clinical experience and research in this area I am very familiar with the risks of reactivation of hepatitis B with this drug. My concern is that the chemotherapy continued to be administered despite the abnormal and worsening LFTs. This likely is a departure from standard of care. Fulminant and lethal Hepatitis B reactivation is a well known complication of anti-cancer therapy and this drug is a well recognized offender. In fact there is a black box warning of this in the product insert. In cases where reactivation is possible and rituximab needs to be given it is standard to administer anti-viral prophylaxis.