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Hepatitis infections could be reactivated by cancer treatments, but few patients are screened for these viruses.

Jan 17, 2019

Hepatitis Common in New Cancer Patients article banner
New York, NY

image of Doctor Dawn L. Hershman, MD, MS

Dawn L. Hershman, MD, MS

Many newly diagnosed cancer patients also are infected with hepatitis B or C virus—and are unaware of their viral status—a new study published in JAMA Oncology has found. Dawn L. Hershman, MD, MS, was a senior leader of the study, which was run by SWOG Cancer Research Network.

Why it matters

“Cancer therapies, especially the new immunotherapies, have the potential to reactivate viral infections,” says Hershman, a professor of medicine and epidemiology at Columbia University Vagelos College of Physicians and Surgeons, leader of the Herbert Irving Comprehensive Cancer Center’s Breast Cancer Program at NewYork-Presbyterian/Columbia University Irving Medical Center, and a senior author of the paper.

“Since patients with viral infections are usually excluded from clinical trials, we don’t know how cancer treatments affect the clinical outcomes of those with hepatitis or HIV,” Hershman adds.

New cancer patients are rarely screened for viral infections. “This is a significant missed clinical opportunity,” Hershman says. “We have effective treatments for HIV and hepatitis B, and hepatitis C can be cured.”

To screen or not to screen

Experts disagree over the value of routine screening for hepatitis B and C and HIV in new cancer patients. “While routine screening would likely be helpful, it would also be very expensive,” says Hershman. “This study is a first step toward determining the prevalence of viral infections among newly diagnosed cancer patients and establishing new screening and treatment guidelines.”

Study details

The researchers screened more than 3,000 newly diagnosed adult cancer patients for hepatitis B (either previous or chronic), hepatitis C, and HIV at 41 academic and community oncology practices around the country.

They discovered that 6.5 percent had a previous hepatitis B infection, 0.6 percent had chronic hepatitis B, 2.4 percent had hepatitis C, and 1.1 percent had HIV. The study also found that 87 percent of patients with a previous hepatitis B infection, 42 percent of those with chronic hepatitis B, and 31 percent of those with hepatitis C didn’t know their viral status before they were screened, though 94 percent of those with HIV were already aware of their status.

What it means

“Clearly, there is a large, hidden reservoir of cancer patients who have hepatitis,” says Hershman. “Our findings suggest that routine screening for hepatitis B and C in new cancer patients may be warranted, particularly if it’s shown to be cost-effective.”

What’s next

The researchers plan to study the cost-effectiveness of viral screening in this patient population. “We also need to gain a better understanding of what factors put patients at risk for viral reactivation and how cancer treatments affect viral infections,” Hershman says.

More details

The paper is titled, “Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV Infection Among Patients with Newly Diagnosed Cancer From Academic and Community Oncology Practices.”

The study was developed and managed by SWOG, which is part of the National Cancer Institute’s National Clinical Trials Network, the oldest and largest publicly funded cancer research network in the U.S. Dr. Hershman is a vice chair of SWOG.

The study was funded by grants from the National Institutes of Health (CA189974, CA180888, CA180819, CA180828, CA180801, CA180858, CA189821, CA189972, CA189854, CA180858, CA189960, CA189817, CA189804, CA139519, CA189872, and CA189953, and legacy grants CA22433, CA46282, and CA76448).

Dr. Hershman reports no financial or other conflicts of interest. The full list of authors and disclosures are listed in the paper.

Columbia University Irving Medical Center newsroom

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