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Hepatitis B and cancer: A practical guide for the oncologist
Claudia Bozza1, Marika Cinausero1, Donatella Iacono1
1Department of Oncology, University Hospital of Udine, Udine, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
Critical Reviews in Oncology/Hematology
|December 15, 2015
Summary
Hepatitis B virus (HBV) reactivation is a serious risk during chemotherapy. Routine screening for chronic HBV infection is recommended for high-risk cancer patients undergoing immunosuppressive treatment.
Area of Science:
- Hepatology
- Oncology
- Virology
Background:
- Hepatitis B virus (HBV) infection poses a global health risk, potentially persisting in immunocompetent individuals.
- Chemotherapy-induced immunosuppression can trigger HBV reactivation, leading to severe complications like liver failure and treatment cessation.
- Occult HBV infection (OBI), characterized by low HBV DNA levels in HBsAg-negative patients, also carries reactivation risks during immunosuppression.
Purpose of the Study:
- To evaluate the necessity and benefit of routine Hepatitis B virus (HBV) screening in all cancer patients undergoing cytotoxic and immunosuppressive chemotherapy.
- To analyze the risks associated with HBV reactivation during chemotherapy in various patient groups, including carriers and those with OBI.
- To inform evidence-based guidelines for HBV screening and management in cancer patients.
Main Methods:
- Literature review of studies investigating HBV reactivation during chemotherapy.
- Analysis of data on the incidence and outcomes of HBV reactivation in cancer patients.
- Examination of current guidelines regarding HBV screening protocols for patients receiving immunosuppressive therapy.
Main Results:
- While prophylactic antiviral treatment shows benefits for at-risk cancer patients, evidence for routine screening in all chemotherapy patients is lacking.
- HBV reactivation is a life-threatening risk for active/inactive HBV carriers and patients with OBI undergoing immunosuppressive treatments.
- Current major guidelines advocate for HBV screening in patients with a high risk of HBV infection or those anticipating significant immunosuppression.
Conclusions:
- Routine HBV screening for all patients undergoing chemotherapy is not yet supported by robust evidence.
- Targeted HBV screening is recommended for cancer patients at high risk of infection or those undergoing treatments expected to cause substantial immunosuppression.
- Proactive management of HBV in cancer patients is crucial to prevent reactivation and ensure uninterrupted anticancer therapy.
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