Treatment
➤ Chronic HBV patients receiving any systemic anticancer therapy should
receive antiviral prophylactic therapy for the duration of anticancer
therapy, as well as for at least 12 months after receipt of the last
anticancer therapy.
• Monitoring recommendations include checking ALT and HBV DNA level at
baseline prior to or at the beginning of their anticancer therapy, as well as every 6
months during antiviral therapy.
• Hepatitis flares, presenting as elevated alanine aminotransferase (ALT) levels, can
occur after the discontinuation of antiviral therapy.
▶ As such, ALT levels should be monitored frequently, at least monthly for the first 3
months after the cessation of antiviral therapy and every 3 months thereafter.
• Coordination of care with a clinician experienced in HBV management is highly
recommended for chronic HBV patients, especially to monitor for withdrawal flares,
determine monitoring and antiviral therapy after the cessation of anticancer therapy,
and to evaluate for advanced liver disease such as cirrhosis or liver cancer. (Strong
recommendation; IC-B)
➤ Hormonal therapy without systemic anticancer therapy is unlikely to
increase the risk of HBV reactivation in patients with chronic or past
HBV.
• Antiviral therapy and management for these patients should follow national HBV
guidelines, independent of cancer therapy, including management by a clinician
experienced in HBV management for prevention of liver disease such as cirrhosis or
liver cancer.
• Should their anticancer treatment regimen change beyond hormonal therapy alone,
the risk of HBV reactivation based on their new anticancer therapy should be
reassessed. (Moderate recommendation; IC-B)
