ASCO Provisional Clinical Opinion Update: HBV Screening for Cancer Patients Before Cancer Therapy
As reported in the Journal of Clinical Oncology by Hwang et al, ASCO has released a provisional clinical opinion update on screening of cancer patients for hepatitis B virus (HBV) infection before cancer treatment to reduce the risk of HBV reactivation. The ASCO consensus panel providing the update was co-chaired by Andrew S. Artz, MD, MS, of University of Chicago, and Jessica P. Hwang, MD, MPH, of The University of Texas MD Anderson Cancer Center. ASCO provided provisional clinical opinion recommendations in 2010. However, there is still evidence of suboptimal HBV screening among patients at high risk for HBV infection or HBV reactivation after chemotherapy.
Key Recommendations
Key recommendations of the clinical opinion update follow:
- 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), since 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) testing 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 alanine transaminase (ALT) levels. Antivirals should be started promptly 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 can monitor HBV DNA and ALT levels and initiate on-demand antivirals.
- Current evidence does not support HBV screening before initiation of cancer therapy in patients who neither have HBV risk factors nor anticipate cancer therapy associated with a high risk of reactivation.
- A minority viewpoint supported a strategy of universal HBsAg and selective anti-HBc testing.
For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
