The American Society of Clinical Oncology (ASCO) suggests that individuals at risk for contracting Hepatitis B (HBV) should be screened before chemotherapy to mitigate the possibility that treatments, which kill cancer cells, can also suppress the immune response and contribute to the reemergence of HBV.
This is especially true in cases where bone marrow and/or stem cell transplantation are preceded by larges doses of a chemotherapy agent. Ritauxan (generic name rituximab; a chemotherapy agent used to treat some forms of cancer) is also implicated in the reawakening of dormant HBV.
Described as a “provisional clinical opinion”, the ASCO recommendation provides clear direction to doctors and other cancer-care givers that changes existing medical protocols to provide newer and more relevant treatment information.
Hepatitis B is a viral infection that can be diagnosed with a simple blood test, and prevented with a vaccine. Failure to eradicate it in a timely fashion can lead to cirrhosis of the liver, liver cancer and liver failure, which can result in death.
At-risk individuals include those who use injection drugs; those who have a sexually-transmitted disease (STD) or multiple sex partners; males who have sex with males; those who live with, or are in contact with, HBV sufferers, including the offspring of HBV mothers; the children of immigrants who come from areas where HBV is endemic (Asia, Africa, Eastern Europe, the Middle East and the Pacific Island nations); health care workers, especially those who handle blood and/or body fluids; and those receiving dialysis.
In response to the ASCO recommendation, the Centers for Disease Control (CDC) have issued updated protocols for HBV screening. These include the advice that not every patient preparing for, or engaging in, chemotherapy needs to be screened, but those who have HBV risk liver failure if the disease is reactivated while chemotherapy is taking place.
The risk is almost as great for individuals who know that they have been exposed to the disease, though the CDC cautions that the decision – to test or not to test – should be made jointly by an individual and his or her doctor based on the risks and benefits of testing.
If tests are positive, doctors may choose to administer antiviral medication before, and during, the chemotherapy regimen, but in no case should chemotherapy be delayed, even though antivirals have been known to diminish chemotherapeutic benefits.
Finally, disclaimers aside, ASCO’s provisional clinical opinions are considered an accurate reflection of expert opinion, and are designed to help doctors and healthcare workers determine the best cancer protocols in light of new and ever-changing information.
