All patients with newly diagnosed cancer who will receive systemic anticancer therapy should be tested for hepatitis B virus (HBV) by 3 tests prior to starting therapy, according to a new ASCO [American Society of Clinical Oncology] Provisional Clinical Opinion Update.1
These tests are hepatitis B surface antigen (HBsAg), hepatitis core antibody (anti-HBc) total immunoglobulin (Ig) or IgG, and antibody to hepatitis B surface antigen (anti-HBs).
The opinion noted that therapy should not be delayed for the results of these screening tests, but that findings of chronic HBV or past HBV infection require further action.
“Patients with chronic HBV receiving systemic anticancer therapy should receive antiviral prophylactic therapy for the duration of anticancer therapy, as well as for at least 12 months after receipt of the last anticancer therapy,” the opinion stated.
According to the opinion, there has been a lack of agreement on the preferred approach to HBV serologic testing for individuals with cancer. As a result, the statement said, HBV testing has been suboptimal.
The first ASCO opinion on the topic issued in 2010 recommended clinicians consider screening people in groups with increased risk for chronic HBV or those who may receive highly immunosuppressive therapies. In 2015, the opinion was updated again to recommend screening in patients before receiving anti-CD20 therapy or stem cell transplant.
Other recommendations in the new opinion include that:
- Hormonal therapy alone should not pose substantial risk for HBV reactivation. These patients can follow noncancer HBV monitoring and treatment guidance.
- Patients with past HBV receiving cancer treatment associated with established high risk of HBV reactivation should be started on antiviral prophylaxis at the start of anticancer therapy and continued on antiviral therapy for at least 12 months after anticancer therapy is completed.
- Patients with past HBV starting anticancer therapies not clearly associated with high risk of HBV reactivation should be carefully followed with HBsAg and ALT testing every 3 months. Antiviral therapy should be started if HBsAg becomes positive or HBV DNA exceeds 1,000 IU/mL in the setting of a hepatitis flare.
“Future studies will be needed to make universal HBV screening and linkage to care efficient and systematic, likely based in EHR systems,” according to the opinion statement. “Ongoing studies of HBV tests such as ultrasensitive HBsAg, HBV RNA, and hepatitis B core antigen, are being studied and may be useful in predicting risk of HBV reactivation.”
Hwang JP, Feld JJ, Hammond SP, et al. Hepatitis B virus screening and management for patients with cancer prior to therapy: ASCO Provisional Clinical Opinion Update. J Clin Oncol. Published online July 27, 2020. doi:10.1200/JCO.20.01757