American Society of Clinical Oncology Provisional Clinical Opinion: Chronic Hepatitis B Virus Infection Screening in Patients Receiving Cytotoxic Chemotherapy for Treatment of Malignant Diseases

Abstract

ASCO's provisional clinical opinions (PCOs) reflect expert consensus based on clinical evidence and literature available at the time they are written, and are intended to assist physicians in clinical decision-making and identify questions and settings for further research. Due to the rapid flow of scientific information in oncology, new evidence may have emerged since the time a PCO was submitted for publication. PCOs are not continually updated and may not reflect the most recent evidence. PCOs address only the topics specifically identified in the PCO and are not applicable to interventions, diseases or stages of disease not specifically identified. PCOs cannot account for individual variation among patients, and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It is the responsibility of the treating physician or other health care provider, relying on independent experience and knowledge of the patient, to determine the best course of treatment for the patient. Accordingly, adherence to any PCO is voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances. ASCO PCOs describe the use of procedures and therapies in clinical practice and cannot be assumed to apply to the use of these interventions in the context of clinical trials. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of ASCO's PCOs, or for any errors or omissions.

Hepatitis B Reactivation and Rituximab in the Oncology Practice

“…Lamivudine can be used if the duration of treatment is Ͻ12 months, whereas alternative antiviral agents (tenofovir or entecavir) may be preferred if anticipated treatment may last longer than 12 months. Prophylaxis should be continued until treatment endpoints are reached for reactivation of hepatitis B in patients with HBV DNA Ͼ2,000 IU/mL (Table 1) [17][18][19]28]. Serum viral load should be monitored in those who are HBsAg positive, as well as close clinical monitoring for potential hepatic injury.…”

“…Routine serologic testing for prior HBV exposure via surface antibody/antigen and core antibody/antigen is now recommended for patients with B-cell NHL. In addition, whereas a recent Provisional Clinical Opinion by the American Society of Clinical Oncology (ASCO) found that there was not enough evidence to determine the benefits of routine screening for chronic HBV infection in cancer patients about to undergo cytotoxic chemotherapy, there are consistent recommendations that screening should be considered in those at high risk for HBV reactivation, particularly those patients who will receive rituximab as part of their therapy [19]. Known HBV carriers should be monitored closely for viral reactivation via serial serum viral loads during therapy and for at least 6 months following completion [28].…”

“…Reactivation of HBV due to the immunosuppressive actions of rituximab has been reported in both HBsAg positive carriers and those with chronic HBV infection [13]. As a result of increasing clinical attention to this matter and recent reports of HBV reactivation, the American Society of Clinical Oncology (ASCO) has recently issued a Provisional Clinical Opinion on HBV screening in patients receiving treatment of malignant diseases [19].…”

HBV treatment in a patient who will be receiving immunosuppressive therapy

“…21 However, the American Society of Clinical Oncology (ASCO) responded to this recommendation with a provisional clinical opinion, stating that ''evidence is insufficient to determine the net benefits and harms of routine screening for chronic HBV infection in individuals with cancer who are about to receive cytotoxic or immunosuppressive therapy.'' 27 Concerns raised by ASCO included the potential for delays in chemotherapy, misinterpretation of HBV serology, toxicity of antiviral therapy, and cost of screening. The first two issues are amenable to educational interventions, and fortunately oral nucleoside and nucleotide analogues for HBV are extremely well tolerated and have no known drug interactions with chemotherapeutic agents.…”

Hepatitis B Virus Infection in B-Cell Non-Hodgkin’s Lymphoma, and Effect of Entecavir in Prophylactic Antiviral Therapy

“…Some studies have indicated that Lamivudine can reduce the incidence of HBV reactivation [22]. Therefore, prophylactic antiviral therapy has been recommended before or at initiation of chemotherapy for all HBsAg-positive NHL patients undergoing systemic chemotherapy [23], but evidence from controlled trials of this prophylactic antiviral therapy is limited [24].…”