Transdisciplinary Approach to Managing Hepatitis C Virus Infection in Patients at a Tertiary Care Cancer Center

Torres, Harrys A.; Roach, Lillian R.; Mahale, Parag; Granwehr, Bruno; Blechacz, Boris; Miller, Ethan; Borchardt, Roy A.; Shukla, Bhavarth; Ericsson, Charles D.; Raad, Issam

doi:10.1093/ofid/ofv133.328

Cited by 2 publications

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“…Simultaneous antiviral and oncologic therapy may also prevent delays in the administration of chemotherapy in HCV‐infected patients with cancer . In some major cancer centers, HCV‐treating physicians (infectious disease specialists and hepatologists), oncologists, and pharmacists work together in the diagnostic work‐up, monitoring, and treatment of HCV‐infected patients …”

Section: Selection and Delivery Of Daa Therapymentioning

confidence: 99%

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The oncologic burden of hepatitis C virus infection: A clinical perspective

Torres

Shigle

Hammoudi

et al. 2017

CA A Cancer J Clinicians

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110

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Chronic hepatitis C virus (HCV) infection affects millions of people worldwide and is associated with cancer. Direct-acting antivirals (DAAs) have changed HCV treatment paradigms, but little is known about management of HCV infection in patients with cancer. The substantial burden of HCV infection in patients with cancer and the inconclusive evidence regarding detection and management of HCV infection in patients with cancer prompted us to review the literature and formulate recommendations. Patients for whom HCV screening is recommended included all patients with hematological malignancies, hematopoietic cell transplant candidates or patients with hepatocellular carcinoma (HCC). There is lack of consensus-based recommendations for the identification of other cancer patients but physicians may consider screening patients belonging to groups at heightened risk of HCV infection including persons born during 1945–1965 and those at high risk for infection. Patients with evidence of HCV infection should be assessed by an expert to evaluate liver disease severity, comorbidities associated with HCV infection, and treatment opportunities. DAA therapy should be tailored on the basis of patient prognosis, type of cancer, cancer treatment plan, and hepatic and virologic parameters. HCV-infected cancer patients with cirrhosis (or even advanced fibrosis) and those at risk for liver disease progression, especially patients with HCV-associated comorbidities, should have ongoing follow-up, regardless of whether there is a sustained virologic response, to ensure timely detection and treatment of HCC. HCV infection and its treatment should not be considered contraindications to cancer treatment and should not delay the initiation of an urgent cancer therapy.

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Section: Selection and Delivery Of Daa Therapymentioning

confidence: 99%

“…Rates of sustained virologic response (SVR), regarded as indicating HCV cure, are now similar in HCV‐infected patients with and without cancer . Differences in the presentation, natural history, and management of HCV infection in patients with and without cancer are presented in Table …”

Section: Introductionmentioning

confidence: 99%

The oncologic burden of hepatitis C virus infection: A clinical perspective

Torres

Shigle

Hammoudi

et al. 2017

CA A Cancer J Clinicians

Self Cite

110

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“…4,5,12,30,31 HCV eradication may prevent liver disease progression, eliminate the risk of enhanced HCV replication, and allow patients access to clinical trials of anticancer therapies. The number of providers with specific training in treating HCV infection in patients with cancer may be limited 32 ; however, oncology providers should reach out to HCV experts for optimal comanagement of patients with cancer and chronic HCV infection receiving anticancer therapy.…”

Section: Chronic Hcv Infection Can Affect Cancer Treatmentmentioning

confidence: 99%

Oncologic Implications of Chronic Hepatitis C Virus Infection

Hwang

LoConte

Rice

et al. 2019

JOP

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Chronic hepatitis C virus (HCV) infection increases the risk for several types of cancer, including hepatocellular carcinoma (HCC) and B-cell non-Hodgkin lymphoma, as primary and second primary malignancies. HCV-infected patients with cancer, particularly those undergoing anticancer therapy, are at risk for development of enhanced HCV replication, which can lead to hepatitis flare and progression of liver fibrosis or cirrhosis. Risk factors for HCV infection include injection drug use, blood transfusion, or solid organ transplantation before 1992, receipt of clotting factor concentrates before 1987, long-term hemodialysis, chronic liver disease, HIV positivity, and occupational exposure. Widely available direct-acting antivirals are highly effective against HCV and well tolerated. Identification of HCV-infected individuals is the essential first step in treatment and eradication of the infection. One-time screening is recommended for persons born from 1945 to 1965; screening is also recommended for persons with risk factors. Recently, a public health recommendation has been drafted to screen all adults age 18 to 79 years. Two oncology organizations recommend screening all patients with hematologic malignancies and hematopoietic cell transplant recipients, and a recently published multicenter prospective study supports universal HCV screening for all patients with cancer. HCV screening entails testing for anti-HCV antibodies in serum and, when results are positive, HCV RNA quantitation to confirm infection. Direct-acting antiviral therapy eradicates HCV in almost all cases. Virologic cure of HCV prevents chronic hepatitis and progression to liver fibrosis or cirrhosis. HCV eradication also decreases the risk of developing HCV-associated primary and second primary malignancies, and it may allow HCV-infected patients access to important cancer clinical trials. Patients with HCV-related cirrhosis require lifelong surveillance for HCC, even after viral eradication.

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Transdisciplinary Approach to Managing Hepatitis C Virus Infection in Patients at a Tertiary Care Cancer Center

Cited by 2 publications

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The oncologic burden of hepatitis C virus infection: A clinical perspective

The oncologic burden of hepatitis C virus infection: A clinical perspective

Oncologic Implications of Chronic Hepatitis C Virus Infection

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