S05 - Management of hepatitis C positive patients undergoing active treatment for malignancies: a position paper from the Associazione Italiana di Oncologia Medica (AIOM) and the Società Italiana di Malattie Infettive e Tropicali (SIMIT)

Abstract

Background: The association of HBV reactivation and anti-cancer drugs is well-known. However, since HCV reactivation is unusual, little information is available in this setting. Aim of our study was to develop, on behalf of AIOM and SIMIT, practical recommendations for the management of HCV+ pts undergoing antitumor treatment. Methods: Data present in the literature were reviewed, including recommendations and expert opinions on HCV+ pts undergoing antitumor therapy. Experts of the Societies provided additional information for clarifying some issues in the absence of clear-cut information from the literature. Results: HCV screening rates are low in cancer pts. The risk of hepatitis C reactivation is higher with immunosuppressive agents. It may be difficult to separate naturally occurring cancer/therapy-related complications from true reactivation of hepatitis. No conclusive data are available concerning the appropriate monitoring of liver function and when an antiviral regimen has to be given. Conclusions: At present, the following recommendations can be reasonably proposed for the management of HCV+ pts undergoing anticancer therapy:•risk-based and birth cohort-based HCV screening, followed by HCV-RNA tests in positive subjects, has to be performed before initiating active cancer treatment;•monitoring of ALT every 3-4 weeks is necessary. If ALT level raises 3 times the normal value, HCV-RNA should be closely monitored for 3 months following treatment discontinuation;•the risk of hepatitis C reactivation is higher in pts receiving immunosuppressive drugs including rituximab, alemtuzumab, steroids and certain chemotherapeutic agents;•in pts at high risk of reactivation of hepatitis C, treatment with antiviral agents is recommended, especially when anticancer therapy is administered with a curative intent;•when reactivation is diagnosed, the decision to proceed with active anticancer therapy and/or initiating antiviral agents should be based on a discussion of prognosis and therapy options for both conditions. As targeted therapies, including checkpoint inhibitors, are an emerging area of oncology, clinicians treating HCV+ infected pts should be mindful of the potential, in the absence of clear cut data, for their immunosuppressive properties;•collaboration with a hepatologist or an infectious disease specialist is necessary in the management of HCV+ cancer pts. Studies are needed to identify optimal strategies for diagnosis and treatment of this pts.