Background: Currently there are no international consensus on screening guidelines for Hepatitis B virus (HBV) prior to initiation of immunotherapy. Hepatitis B management during immunosuppression for haematological and solid-organ malignancies: Australian consensus statement 2019 recommend routine screening for Hepatitis B viral serology ideally prior to commencement of cancer therapy for all patients with solid organ tumors (both curative and non-curative intent). However, Cancer Institute of New South Wales site eviQ Medical Oncology Reference Committee consensus opinion is that routine screening for HBV is not usually recommended for patients with incurable solid cancers.
Aim: This study aims to review the current HBV screening practice and risk of HBV reactivation with immunotherapy at Cairns and Hinterland Hospital and Health Services (CHHHS).
Methods: Electronic records of patients who received immunotherapy from 2015 to 2019 were reviewed for pre-treatment HBV screening, antiviral treatment and HBV reactivation. Results from within one year before the commencement of ICI were accepted as eligible baseline screening results.
Results: 186 advanced cancer patients were treated with ICI. 127 patients (68.28%) were screened for Hepatitis B serology. No patient was found to have HBsAg positivity and 9 patients were found to have HBcAb positivity without HBsAg positivity. None of the patients were treated with antiviral therapy and none developed hepatitis B reactivation during the immunotherapy until study censored date of 27/05/2020.
Conclusion: This study provides an insight into current HBV screening practice at CHHHS in delivery of immunotherapy for advanced cancer patients and the minimal risk of the HBV reactivation associated with it. We agree with eviQ Medical Oncology Reference Committee consensus opinion that routine screening for HBV is not recommended for patients with incurable solid cancers prior to immunotherapy and clinician should assess risk of HBV infection of their patients on individual basis prior to screening.