General Discussions

Hepatitis B Screening

By Lisa Schulmeister, RN, MN, APRN-BC, OCN, FAAN
In May 2015, the American Society of Clinical Oncology (ASCO) updated its clinical guideline on hepatitis B virus screening prior to initiating cancer treatment. Although ASCO issued clinical recommendations in 2010, the expert panel updating the guidelines noted that there is still evidence of suboptimal hepatitis B virus (HBV) screening among patients at high risk for HBV infection or HBV reactivation after chemotherapy. The updated provisional clinical opinion is a risk-adaptive strategy to identify and treat patients with HBV infection to reduce their risk of HBV reactivation.

ASCO recommends that patients are screened for HBV infection prior to starting anti-CD20 therapy or undergoing hematopoietic cell transplantation. Patients with risk factors for HBV infection also should be screened, and screening should include both the hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc), because reactivation can occur in patients who are HBsAg positive/anti-HBc positive or HBsAg negative/anti-HBc positive. Either a total anti-HBc or anti-HBc immunoglobulin G (not immunoglobulin M) test should be used.

Antiviral therapy should be started for patients who are HBsAg-positive/anti-HBc–positive before or concurrent with the start of cancer treatment. HBsAg-negative/anti-HBc–positive patients should be monitored for reactivation with HBV DNA and ALT levels, and antivirals should be promptly started if reactivation occurs. Antivirals for HBsAg-negative/anti-HBc–positive patients anticipating cancer therapies associated with a high risk of reactivation can be initiated, or these patients can have their HBV DNA and ALT levels monitored, with initiation of antivirals when indicated.

Current evidence does not support HBV screening before initiation of cancer therapy for patients who neither have HBV risk factors nor anticipate cancer therapy associated with a high risk of reactivation.

Hwang JP, Somerfield MR, Alston-Johnson DE, et al. Hepatitis B virus screening for patients with cancer before therapy: American Society of Clinical Oncology Provisional Clinical Opinion Update. JCO; published online before print May 11, 2015, doi: 10.1200/JCO.2015.61.3745.
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