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. 2015 Jul 1;33(19):2212-20.
doi: 10.1200/JCO.2015.61.3745. Epub 2015 May 11.

Hepatitis B Virus Screening for Patients With Cancer Before Therapy: American Society of Clinical Oncology Provisional Clinical Opinion Update

Jessica P Hwang  1 , Mark R Somerfield  1 , Devena E Alston-Johnson  1 , Donna R Cryer  1 , Jordan J Feld  1 , Barnett S Kramer  1 , Anita L Sabichi  1 , Sandra L Wong  1 , Andrew S Artz  1
Affiliations

Hepatitis B Virus Screening for Patients With Cancer Before Therapy: American Society of Clinical Oncology Provisional Clinical Opinion Update

Jessica P Hwang et al. J Clin Oncol. .

Abstract

Purpose: This updated provisional clinical opinion presents a revised opinion based on American Society of Clinical Oncology panel consensus in the context of an evolving database.

Context: Despite the 2010 provisional clinical opinion recommendation, there is still evidence of suboptimal hepatitis B virus (HBV) screening among patients at high risk for HBV infection or HBV reactivation after chemotherapy. This updated provisional clinical opinion introduces a risk-adaptive strategy to identify and treat patients with HBV infection to reduce their risk of HBV reactivation.

Provisional clinical opinion: Medical providers should screen by testing patients for HBV infection before starting anti-CD20 therapy or hematopoietic cell transplantation. Providers should also screen patients with risk factors for HBV infection. Screening should include both hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc), because reactivation can occur in patients who are HBsAg positive/anti-HBc positive or HBsAg negative/anti-HBc positive. Either total anti-HBc or anti-HBc immunoglobulin G (not immunoglobulin M) test should be used. Clinicians should start antiviral therapy for HBsAg-positive/anti-HBc-positive patients before or contemporaneously with cancer therapy and monitor HBsAg-negative/anti-HBc-positive patients for reactivation with HBV DNA and ALT levels, promptly starting antivirals if reactivation occurs. Clinicians can initiate antivirals for HBsAg-negative/anti-HBc-positive patients anticipating cancer therapies associated with a high risk of reactivation, or they can monitor HBV DNA and ALT levels and initiate on-demand antivirals. For patients who neither have HBV risk factors nor anticipate cancer therapy associated with a high risk of reactivation, current evidence does not support HBV screening before initiation of cancer therapy. Two panel members provided a minority viewpoint, involving a strategy of universal HBsAg and selective anti-HBc testing.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Proposed diagnostic criteria for hepatitis B virus (HBV) reactivation. Patients with chronic HBV infection (hepatitis B surface antigen [HBsAg] –positive and hepatitis B core antibody [anti-HBc] –positive test results) can have either increase in HBV DNA level or appearance of HBV DNA, depending on whether they did or did not have detectable HBV DNA before immunosuppression, respectively. Patients with clinically resolved HBV infection (HBsAg negative and anti-HBc positive) can be diagnosed as having HBV reactivation on appearance of HBsAg or HBV DNA. Adapted with permission.
Fig 2.
Fig 2.
Risk-adaptive hepatitis B virus (HBV) screening and management decision-making algorithm for patients with cancer before immunosuppressive therapy. anti-HBc, antihepatitis B core antibody (either total or immunoglobulin G); HBsAg, hepatitis B surface antigen.
See this image and copyright information in PMC

Comment in

References

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    1. Hwang JP, Fisch MJ, Zhang H, et al. Low rates of hepatitis B virus screening at the onset of chemotherapy. J Oncol Pract. 2012;8:e32–e39. - PMC - PubMed
    1. Hwang JP, Fisch MJ, Lok AS, et al. Trends in hepatitis B virus screening at the onset of chemotherapy in a large US cancer center. BMC Cancer. 2013;13:534. - PMC - PubMed
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