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- 1 Monash University, Melbourne, VIC
- 2 Disease Elimination Program, Burnet Institute, Melbourne, VIC
- 3 Alfred Health, Melbourne, VIC
- 4 Peter MacCallum Cancer Institute, Melbourne, VIC
- 5 University of Melbourne, Melbourne, VIC
- 6 St Vincent's Hospital, Melbourne, VIC
- 7 AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
- 8 University of Sydney, Sydney, NSW
- 9 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC
- 10 Royal Brisbane Hospital, Brisbane, QLD
- 11 Australian Centre for Blood Diseases, Melbourne, VIC
- 12 Royal Hobart Hospital, Hobart, TAS
- 13 University of Tasmania, Hobart, TAS
- 14 Royal Adelaide Hospital, Adelaide, SA
Correspondence: Joseph.Doyle@monash.edu
Competing interests:
This document was produced independently from industry funding, with support from a competitive funding grant from the Western and Central Melbourne Integrated Cancer Service. Joseph Doyle receives unrelated investigator‐initiated research grants to his institution from Gilead Sciences, AbbVie, Merck/MSD, and Bristol Myers Squibb; received honoraria to his institution for speaking from Gilead Sciences, Merck/MSD, Bristol Myers Squibb, and AbbVie. Simone Strasser received honoraria for advisory boards and speaking from Gilead Sciences, Bristol‐Myers Squibb, AbbVie, MSD, Norgine, Bayer, Eisai, Ipsen, Pfizer, Astellas and Novartis. Joseph Sasadeusz receives research grants from Gilead Sciences. Anna Johnston received honoraria for advisory boards from Roche, Janssen and MSD; and received financial support to attend an education meeting from Roche. Narin Bak receives research grants to his institution from Gilead Sciences for chronic hepatititis B research. Alexander Thompson received research grant support from Gilead Sciences and AbbVie; is a consultant/advisor to Gilead Sciences, AbbVie, BMS, Merck/MSD, Eisai and Bayer; and received honoraria for speaking from Gilead Sciences, AbbVie, Merck/MSD, Bristol‐Myers Squibb and Eli Lilly.
- 1. MacLachlan J, Allard N, Carville K, et al. Mapping progress in chronic hepatitis B: geographic variation in prevalence, diagnosis, monitoring and treatment, 2013–15. Aust N Z J Public Health 2018; 42: 62–68.
- 2. Cowie B, Karapanagiotidis T, Enriquez A, Kelly H. Markers of hepatitis B virus infection and immunity in Victoria, Australia, 1995 to 2005. Aust N Z J Public Health 2010; 34: 72–78.
- 3. Australian Institute of Health and Welfare. Cancer in Australia: Actual incidence data from 1982 to 2013 and mortality data from 1982 to 2014 with projections to 2017. Asia Pac J Clin Oncol 2018; 14: 5–15.
- 4. Reddy KR, Beavers KL, Hammond SP, et al. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology 2015; 148: 215–219.
- 5. European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol 2017; 67: 370.
- 6. Lubel JS, Angus PW. Hepatitis B reactivation in patients receiving cytotoxic chemotherapy: Diagnosis and management. J Gastroenterol Hepatol 2010; 25: 864–871.
- 7. Mallet V, van Bömmel F, Doerig C, et al. Management of viral hepatitis in patients with haematological malignancy and in patients undergoing haemopoietic stem cell transplantation: Recommendations of the 5th European Conference on Infections in Leukaemia (ECIL‐5). Lancet Infect Dis 2016; 16: 606–617.
- 8. Paul S, Saxena A, Terrin N, et al. Hepatitis b virus reactivation and prophylaxis during solid tumor chemotherapy: A systematic review and meta‐analysis. Ann Intern Med 2016; 164: 30–40.
- 9. Perrillo RP, Gish R, Falck‐Ytter YT. American Gastroenterological Association Institute technical review on prevention and treatment of hepatitis b virus reactivation during immunosuppressive drug therapy. Gastroenterology 2015; 148: 221–244.e3.
- 10. Lok ASF, Liang RHS, Chiu EKW, et al. Reactivation of hepatitis B virus replication in patients receiving cytotoxic therapy. Gastroenterology 1991; 100: 182–188.
- 11. Lau GKK, Yiu HHY, Fong DYT, et al. Early is superior to deferred preemptive lamivudine therapy for hepatitis B patients undergoing chemotherapy. Gastroenterology 2003; 125: 1742–1749.
- 12. Yeo W, Chan PKS, Hui P, et al. Hepatitis B virus reactivation in breast cancer patients receiving cytotoxic chemotherapy: a prospective study. J Med Virol 2003; 70: 553–561.
- 13. Liu Z, Jiang L, Liang G, et al. Hepatitis B virus reactivation in breast cancer patients undergoing chemotherapy: A review and meta‐analysis of prophylaxis management. J Viral Hepat 2017; 24: 561–572.
- 14. Lin GN, Peng JW, Xiao JJ, et al. Hepatitis B virus reactivation in hepatitis B surface antigen seropositive patients with metastatic non‐small cell lung cancer receiving cytotoxic chemotherapy: the efficacy of preemptive lamivudine and identification of risk factors. Med Oncol 2014; 31: 119.
- 15. Wu Y‐T, Li X, Liu Z‐L, et al. Hepatitis B virus reactivation and antiviral prophylaxis during lung cancer chemotherapy: a systematic review and meta‐analysis. PLoS One 2017; 12: e0179680.
- 16. Yang Y, Du Y, Luo WX, et al. Hepatitis B virus reactivation and hepatitis in gastrointestinal cancer patients after chemotherapy. Cancer Chemother Pharmacol 2015; 75: 783–790.
- 17. Jang JW, Choi JY, Bae SH, et al. A randomized controlled study of preemptive lamivudine in patients receiving transarterial chemo‐lipiodolization. Hepatology 2006; 43: 233–240.
- 18. Yeo W, Hui EP, Chan ATC, et al. Prevention of hepatitis B virus reactivation in patients with nasopharyngeal carcinoma with lamivudine. Am J Clin Oncol 2005; 28: 379–384.
- 19. Mozessohn L, Chan KKW, Feld JJ, Hicks LK. Hepatitis B reactivation in HBsAg‐negative/HBcAb‐positive patients receiving rituximab for lymphoma: a meta‐analysis. J Viral Hepat 2015; 22: 842–849.
- 20. Yeo W, Chan TC, Leung NWY, et al. Hepatitis B virus reactivation in lymphoma patients with prior resolved hepatitis B undergoing anticancer therapy with or without rituximab. J Clin Oncol 2009; 27: 605–611.
- 21. Lok ASF, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology 2009; 50: 661–662.
- 22. Terrault NA, Bzowej NH, Chang K‐M, et al. AASLD guidelines for treatment of chronic hepatitis B. Hepatology 2016; 63: 261–283.
- 23. Sarin SK, Kumar M, Lau GK, et al. Asian‐Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int 2016; 10: 1–98.
- 24. 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. J Clin Oncol 2015; 33: 2212.
- 25. Guyatt GH, Oxman AD, Kunz R, et al. GRADE: going from evidence to recommendations. BMJ 2008; 336: 1049–1051.
- 26. Zurawska U, Hicks LK, Woo G, et al. Hepatitis B virus screening before chemotherapy for lymphoma: a cost‐effectiveness analysis. J Clin Oncol 2012; 30: 3167–3173.
- 27. Eckman MH, Kaiser TE, Sherman KE. The cost‐effectiveness of screening for chronic hepatitis B infection in the United States. Clin Infect Dis 2011; 52: 209–214.
- 28. Bréchot C, Degos F, Lugassy C, et al. Hepatitis B virus DNA in patients with chronic liver disease and negative tests for hepatitis B surface antigen. N Eng J Med 1985; 312: 270–276.
- 29. Chemin I, Jeantet D, Kay A, Trépo C. Role of silent hepatitis B virus in chronic hepatitis B surface antigen(‐) liver disease. Antiviral Res 2001; 52: 117–123.
- 30. Pei SN, Ma MC, Wang MC, et al. Analysis of hepatitis B surface antibody titers in B cell lymphoma patients after rituximab therapy. Ann Hematol 2012; 91: 1007–1012.
- 31. Cho Y, Yu SJ, Cho EJ, et al. High titers of anti‐HBs prevent rituximab‐related viral reactivation in resolved hepatitis B patient with non‐Hodgkin's lymphoma. J Med Virol 2016; 88: 1010–1017.
- 32. Levy P, Marcellin P, Martinot‐Peignoux M, et al. Clinical course of spontaneous reactivation of hepatitis B virus infection in patients with chronic hepatitis B. Hepatology 1990; 12: 570–574.
- 33. Evens AM, Jovanovic BD, Su YC, et al. Rituximab‐associated hepatitis B virus (HBV) reactivation in lymphoproliferative diseases: meta‐analysis and examination of FDA safety reports. Ann Oncol 2011; 22: 1170–1180.
- 34. Dong HJ, Ni LN, Sheng GF, et al. Risk of hepatitis B virus (HBV) reactivation in non‐Hodgkin lymphoma patients receiving rituximab‐chemotherapy: A meta‐analysis. J Clin Virol 2013; 57: 209–214.
- 35. Hwang JP, Fisch MJ, Zhang H, et al. Low rates of hepatitis B virus screening at the onset of chemotherapy. J Oncol Pract 2012; 8: e32–e39.
- 36. Huang Y‐H, Hsiao L‐T, Hong Y‐C, et al. Randomized controlled trial of entecavir prophylaxis for rituximab‐associated hepatitis B virus reactivation in patients with lymphoma and resolved hepatitis B. J Clin Oncol 2013; 31: 2765–2772.
- 37. Hsu C, Hsiung CA, Su I‐J, et al. A revisit of prophylactic lamivudine for chemotherapy‐associated hepatitis B reactivation in non‐Hodgkin's lymphoma: a randomized trial. Hepatology 2008; 47: 844–853.
- 38. Buti M, Manzano ML, Morillas RM, et al. Randomized prospective study evaluating tenofovir disoproxil fumarate prophylaxis against hepatitis B virus reactivation in anti‐HBc‐positive patients with rituximab‐based regimens to treat hematologic malignancies: the Preblin study. PLoS One 2017; 12: e0184550.
- 39. Long M, Jia W, Li S, et al. A single‐center, prospective and randomized controlled study: Can the prophylactic use of lamivudine prevent hepatitis B virus reactivation in hepatitis B s‐antigen seropositive breast cancer patients during chemotherapy? Breast Cancer Res Treat 2011; 127: 705.
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Abstract
Introduction: Individuals with chronic hepatitis B virus (HBV) infection or past exposure to HBV infection have a substantial risk of reactivation during immunosuppressive cancer therapy. HBV reactivation can lead to liver failure, cancer treatment interruption or death. Clinical concordance with screening and treatment guidelines is inconsistent in practice, and existing international guidelines are not specific to the Australian context. We developed an Australian consensus statement with infectious diseases, hepatology, haematology and oncology specialists to inform hepatitis B screening and antiviral management for immunocompromised patients with haematological and solid organ malignancies in Australia.
Main recommendations: Recommendations address four key areas of HBV infection management for immunocompromised patients with haematological and solid organ malignancies: who to test for HBV infection, when to start antiviral agents, when to stop antiviral agents, and how to monitor patients during cancer therapy. We recommend testing all patients undergoing cancer treatment for hepatitis B (including HBV surface antigen [HBsAg], HBV core antibody [anti‐HBc], and HBV surface antibody) before cancer treatment. Individuals with chronic HBV infection (HBsAg positive) or past exposure (HBsAg negative and anti‐HBc positive) receiving higher risk chemotherapy require antiviral prophylaxis using entecavir or tenofovir.
Changes in management as a result of this statement: This consensus statement will simplify the approach to testing and prophylaxis for HBV infection during cancer therapy, and harmonise approaches to discontinuing and monitoring individuals which have been highly variable in practice. We advocate for broader Medicare Benefits Schedule and Pharmaceutical Benefits Scheme access to HBV testing and treatment for patients undergoing cancer therapy.