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면역억제제 혹은 항암 치료가 필요한 B형간염 환자의 치료
장정원 ( Jeong Won Jang ) 대한내과학회 2012 대한내과학회지 Vol.82 No.2
Reactivation of hepatitis B virus (HBV) has been well documented as a complication in HBV surface antigen (HBsAg) carriers who receive cytotoxic or immunosuppressive therapy. With the recent introduction of newer agents with a high level of immunosuppressive effect, this unfavorable event often occurs in patients with HBsAg-negative and/or occult HBV infection. The first step in HBV reactivation management is the identification of the patients at risk of viral reactivation by testing for HBV serology prior to commencing immunosuppressive treatment or chemotherapy. Multiple publications have consistently indicated the benefit of prophylactic or preemptive antiviral therapy in this setting, and justified such approach before the start of cytotoxic therapy. Unresolved issues concerning such prophylactic approach remain in the situations of HBsAg-negative/anti-HBc-positive or negative status, which presumably consists of a large number of occult HBV infection cases. This topic review will summarize clinical issues related to HBV reactivation, focusing clinical manifestations, risk factors associated with HBV reactivation, and a growing body of evidence supporting preventive antiviral therapy in high-risk patients. (Korean J Med 2012;82:149-158)
Cons: Treating CHB patients in Immune-tolerance phase
장정원 ( Jeong Won Jang ) 대한간학회 2017 간학회 싱글토픽 심포지움 Vol.2017 No.1
Despite the availability of potent antiviral drugs, current guidelines do not recommend anti-HBV therapy but close monitoring with serial aminotransferases and HBV DNA measurements for chronic hepatitis B patients in the immune tolerant phase. Such recommendation is based on the previous observations that the risk of disease progression and the chance of a sustained response with anti-HBV agents are low. However, only monitoring instead of treating immune tolerant patients can raise a concern especially when managing elderly patients or those with a family history of hepatocellular carcinoma (HCC). In fact, some of them often reportedly have advanced fibrosis or are at higher risk of advanced liver diseases. Continued high HBV replication in such patients could increase the risk of disease progression or development of HCC. Thus, the optimal management of patients in the immune tolerant phase can often be individualized according to age or family history. A liver biopsy and/or non-invasive assessment of fibrosis may be helpful to determine the therapeutic strategy when patients’ age is over 40 or there is clinical suspicion of advanced liver disease. Recent studies suggest that T cell immunity against HBV is relatively preserved especially in young patients. Thus, it is urgent that definitive criteria for immune tolerant phase of chronic HBV infection should be introduced before we develop the optimal management strategy in this setting.
간세포암종 진단 및 예후예측에서의 CTC 및 Exosomal miRNA의 유용성
장정원 ( Jeong Won Jang ) 대한간학회 2021 임상연구방법론워크숍 Vol.2021 No.1
Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver and one of the leading causes of cancer-related mortality worldwide. The etiology of HCC IS varied with a range of different presentations and natural histories. Despite the recent advances in treatments, the overall prognosis of HCC still remains unsatisfactory. Especially, patients with advanced-stage HCCs suffer from poor survival rates and this requires the discovery of novel, efficient Diomarkers for early diagnosis and prognosis of HCC, identifying risk factors, distinguishing HCC from non-HCC liver diseases, and assessment of treatment response. Liquid biopsy has emerged as a novel minimally invasive approach to enable early diagnosis and monitoring tumor progression, metastasis, and recurrence of HCC. Next-generation sequencing (NGS) technologies provide accurate and comprehensive gene expression and mutational profiling of liquid biopsies including cell-free circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), and genomic components of extracellular vesicles (EVs) including micro-RNAs (miRNAs), long non-coding RNAs (IncRNAs) and circular RNAs(circRNAs). HCC Is a highly heterogeneous malignancy, patients with HCC can display various genomic, epigenomic, and transcriptomic patterns and exhibit varying sensitivity to treatment options. Identification of individual variabilities in genomic signatures in liquid biopsy has the potential to greatly enhance precision oncology capabilities. Herein, the short summary will provide a brief review of commonly used liquid biopsies, such as CTCs and miRNAs, in HCC and discuss the latest progress in their application for advancing HCC personalized medicine.