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Hepatitis B management during immunosuppression for haematological and solid organ malignancies: an Australian consensus statement

Joseph Doyle, Michelle Raggatt, Monica Slavin, Sue‐Anne McLachlan, Simone I Strasser, Joseph J Sasadeusz, Jessica Howell, Krispin Hajkowicz, Harshal Nandurkar, Anna Johnston, Narin Bak and Alexander J Thompson
Med J Aust 2019; 210 (10): . || doi: 10.5694/mja2.50160
Published online: 20 May 2019

Abstract

Introduction: Individuals with chronic hepatitis B virus (HBV) infection or past exposure to HBV infection have a substantial risk of reactivation during immunosuppressive cancer therapy. HBV reactivation can lead to liver failure, cancer treatment interruption or death. Clinical concordance with screening and treatment guidelines is inconsistent in practice, and existing international guidelines are not specific to the Australian context. We developed an Australian consensus statement with infectious diseases, hepatology, haematology and oncology specialists to inform hepatitis B screening and antiviral management for immunocompromised patients with haematological and solid organ malignancies in Australia.

Main recommendations: Recommendations address four key areas of HBV infection management for immunocompromised patients with haematological and solid organ malignancies: who to test for HBV infection, when to start antiviral agents, when to stop antiviral agents, and how to monitor patients during cancer therapy. We recommend testing all patients undergoing cancer treatment for hepatitis B (including HBV surface antigen [HBsAg], HBV core antibody [anti‐HBc], and HBV surface antibody) before cancer treatment. Individuals with chronic HBV infection (HBsAg positive) or past exposure (HBsAg negative and anti‐HBc positive) receiving higher risk chemotherapy require antiviral prophylaxis using entecavir or tenofovir.

Changes in management as a result of this statement: This consensus statement will simplify the approach to testing and prophylaxis for HBV infection during cancer therapy, and harmonise approaches to discontinuing and monitoring individuals which have been highly variable in practice. We advocate for broader Medicare Benefits Schedule and Pharmaceutical Benefits Scheme access to HBV testing and treatment for patients undergoing cancer therapy.

  • Joseph Doyle1,2,3
  • Michelle Raggatt2,3
  • Monica Slavin4,5
  • Sue‐Anne McLachlan5,6
  • Simone I Strasser7,8
  • Joseph J Sasadeusz3,9
  • Jessica Howell6
  • Krispin Hajkowicz10
  • Harshal Nandurkar1,11
  • Anna Johnston12,13
  • Narin Bak14
  • Alexander J Thompson5,6

  • 1 Monash University, Melbourne, VIC
  • 2 Disease Elimination Program, Burnet Institute, Melbourne, VIC
  • 3 Alfred Health, Melbourne, VIC
  • 4 Peter MacCallum Cancer Institute, Melbourne, VIC
  • 5 University of Melbourne, Melbourne, VIC
  • 6 St Vincent's Hospital, Melbourne, VIC
  • 7 AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
  • 8 University of Sydney, Sydney, NSW
  • 9 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC
  • 10 Royal Brisbane Hospital, Brisbane, QLD
  • 11 Australian Centre for Blood Diseases, Melbourne, VIC
  • 12 Royal Hobart Hospital, Hobart, TAS
  • 13 University of Tasmania, Hobart, TAS
  • 14 Royal Adelaide Hospital, Adelaide, SA

Correspondence: Joseph.Doyle@monash.edu

Competing interests:

This document was produced independently from industry funding, with support from a competitive funding grant from the Western and Central Melbourne Integrated Cancer Service. Joseph Doyle receives unrelated investigator‐initiated research grants to his institution from Gilead Sciences, AbbVie, Merck/MSD, and Bristol Myers Squibb; received honoraria to his institution for speaking from Gilead Sciences, Merck/MSD, Bristol Myers Squibb, and AbbVie. Simone Strasser received honoraria for advisory boards and speaking from Gilead Sciences, Bristol‐Myers Squibb, AbbVie, MSD, Norgine, Bayer, Eisai, Ipsen, Pfizer, Astellas and Novartis. Joseph Sasadeusz receives research grants from Gilead Sciences. Anna Johnston received honoraria for advisory boards from Roche, Janssen and MSD; and received financial support to attend an education meeting from Roche. Narin Bak receives research grants to his institution from Gilead Sciences for chronic hepatititis B research. Alexander Thompson received research grant support from Gilead Sciences and AbbVie; is a consultant/advisor to Gilead Sciences, AbbVie, BMS, Merck/MSD, Eisai and Bayer; and received honoraria for speaking from Gilead Sciences, AbbVie, Merck/MSD, Bristol‐Myers Squibb and Eli Lilly.

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