A selective screening model may help to identify patients receiving anticancer treatment who are at risk of reactivating a hepatitis B virus (HBV) infection, according to research published in the Journal of Clinical Oncology.1
Patients with HBV receiving anticancer therapy can have virus reactivation resulting from immunosuppression. HBV reactivation is, furthermore, linked with liver failure and mortality. The best method for identifying patients with inactive HBV infection is, however, unclear.
For this prospective study, researchers enrolled 2206 patients initiating anticancer treatment at MD Anderson Cancer Center to determine whether a 19-question demographics survey would help to identify patients with HBV prior to treatment.
Of enrolled patients, 2124 completed the survey and HBV testing. The mean patient age was 58 years, 54% were female, and 77% were non-Hispanic white. Twenty percent had a hematologic malignancy and 80% had a solid tumor. One percent of patients had a hepatocellular carcinoma.
Among all included patients, 0.3% had a chronic HBV infection and 6% had prior HBV infection. Chronic or prior infection was most common in Asian patients (31%), followed by nearly 16% in African Americans and 4.6% in white patients.
Patients born outside the United States were the most likely (about 18%) to have HBV infection; about 15% of patients with a parent born outside the US had HBV infection. Less than 5% of patients born in the US with a parent born in the US had HBV infection.
Over 42% of men who had sex with other men and nearly 28% of past injected drug–users had an HBV infection.
The authors noted that “all patients with chronic or past HBV infection would have been identified if we had serologically tested all patients with at least one affirmative answer to any of the survey’s 19 questions.”
They concluded, however, that more than 90% of patients using the survey would require verification through direct HBV testing. More study is needed.
- Hwang JP, Lok AS, Fisch MJ, et al. Models to predict hepatitis B virus infection among patients with cancer undergoing systemic anticancer therapy: a prospective cohort study. J Clin Oncol. 2018 Feb 15. doi: 10.1200/JCO.2017.75.6387 [Epub ahead of print]