Varicella zoster virus infection during chemotherapy in solid cancer patients

Background: Varicella zoster virus (VZV) infection is a representative opportunistic infection in patients with hematological malignancies, with a high incidence of 30-50%. Many studies on the risk factors of VZV infection in this patient group have been conducted. However, few data have been reported exploring VZV infection during systemic chemotherapy in solid cancer patients. Patients and Methods: We retrospectively analyzed 92 patients diagnosed with VZV infection between April 2001 and July 2010 during systemic chemotherapy for solid tumors. All patients had received antiviral prophylaxis for VZV. Results: The median age at the time of diagnosis of VZV infection was 60.8 years (range 30.1-83.0) and the majority of patients (79.3%) did not have comorbidities. Eighty-one patients (88%) received chemotherapy for locally advanced or metastatic/recurrent disease and 11 (12.0%) had adjuvant chemotherapy after curative resection. Of 92 patients, 14 (15.2%) had non-small cell lung cancer and 10 (10.9%) breast cancer. All patients had a median of 2 metastatic lesions (range 0-4). At the time of diagnosis, 55 patients (59.8%) were receiving first-line chemotherapy and 15 (16.3%) more than third-line chemotherapy. The mean white blood cell, platelet and albumin level was 5,736/μl, 205.7 × 10 ³ and 3.8 mg/dl, respectively. On analysis for disease evaluation at the time nearest to diagnosis of VZV infection, only 14 patients (15.2%) revealed tumor response to chemotherapy. After the diagnosis of VZV infection, all patients were treated with antiviral agents. None of the patients experienced failure of therapy for VZV. Conclusion: We reported VZV infection during systemic chemotherapy in solid cancer patients. Patients may have a relatively poor tumor response to chemotherapy at the time nearest to diagnosis of VZV infection. A prospective or matched controlled trial is needed to confirm this finding.