Treatment
Figure 1. Hepatitis B Virus Screening and Management for
Patients with Cancer Prior to Therapy Algorithm
Evidence of HBV infection
a
Conduct HBsAg, anti-HBc (total Ig or IgG), and anti-HBs testing
before anticancer therapy
Systemic anticancer therapy
(cytotoxic, immunotherapy
or targeted therapy)
Hormonal anticancer
therapy alone
Start antiviral prophylaxis,
continue at least 12 mos
after last anticancer
therapy.
No antiviral prophylaxis
unless antiviral treatment
is needed independent of
anticancer therapy.
• Check HBV DNA and ALT at
baseline and every 6 mos
during antiviral therapy
• After anticancer therapy,
monitor ALT for hepatitis
flares,
e
after stopping
antiviral therapy.
• May need long term antiviral
therapy.
For Chronic HBV
Consult HBV
specialist, if
available, for
consideration
of long-term
antiviral therapy.
f
Consult HBV specialist for
co-management, if available.
CHRONIC HBV
HBsAg+
a
Evidence of hepatitis B virus (HBV) infection refers to hepatitis B surface antigen
(HBsAg )–positive or hepatitis B core antibody (HBc)–positive (either total
immunoglobulin [Ig ] or IgG; do not order IgM unless acute HBV infection
is suspected). If evidence of HBV infection, do not delay anticancer therapy
while obtaining further testing or referrals. See Table 2 for details for serologic
interpretation of HBV screening tests.
b
Past HBV: HBsAg-negative, anti-HBc-positive, regardless of anti-HBs status. A
positive anti-HBs test likely attenuates the risk of reactivation in patients with past
HBV infection (see full text for details).
Antiviral
Therapy
Anticancer
Therapy
Initial
Screening
Monitoring
For Past HBV
No further
monitoring is
necessary.
