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)

Semin Oncol. 2018 Oct;45(5-6):259-263. doi: 10.1053/j.seminoncol.2018.07.004. Epub 2018 Oct 25.

Abstract

Purpose: To develop, on behalf of Associazione Italiana di Oncologia Medica and Società Italiana di Malattie Infettive e Tropicali, evidence-based and practical recommendations for the management of cancer patients who are Hepatitis C virus (HCV)-positive and are undergoing antitumor treatment.

Methods: Recommendations were generated by panel of experts selected by the boards of the Societies Associazione Italiana di Oncologia Medica and Società Italiana di Malattie Infettive e Tropicali (4 oncologists and 6 infectious disease and hepatology specialist). The level of evidence and grade or recommendation was assessed according to the Grading of Recommendations Assessment, Development and Evaluation for practice guidelines [5]: A (high), B (moderate), and C (low), together with 2 recommendation levels: 1 (strong), and 2 (weak). Experts provided additional information, which helped greatly in clarifying some issues in the absence of clear-cut information from the literature. The final draft was then submitted to the evaluation of experts and the text modified according to their suggestion and comments.

Results: HCV screening rates are low in patients with malignancies. The risk of reactivation or exacerbation of hepatitis C is higher in patients receiving immunosuppressive agents. It may be difficult to discriminate naturally occurring cancer-related complications from true reactivation or exacerbation of hepatitis C and hepatotoxicity due to cancer treatment. No conclusive data are available concerning the appropriate monitoring of liver function and when an antiviral regimen should be proposed.

Conclusions: Patients at risk of any flare of HCV-related liver disease during active therapy for cancer should be managed with a multidisciplinary approach where all relevant diagnostic techniques and therapeutic resources are available. Prospective studies are needed to identify optimal strategies for the management of HCV infected cancer patients.

Keywords: Anticancer treatment; Hepatitis C; Reactivation.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antiviral Agents / therapeutic use
  • Disease Management
  • Disease Progression
  • Genotype
  • Hepacivirus* / drug effects
  • Hepacivirus* / physiology
  • Hepatitis C / complications*
  • Hepatitis C / diagnosis
  • Hepatitis C / drug therapy
  • Hepatitis C / virology*
  • Humans
  • Italy
  • Neoplasms / complications*
  • Neoplasms / diagnosis
  • Neoplasms / etiology
  • Neoplasms / therapy*
  • Practice Guidelines as Topic
  • Risk Assessment
  • Risk Factors
  • Virus Activation / drug effects

Substances

  • Antiviral Agents