Hepatitis C reactivation in cancer treatment


100 patients with hepatitis C receiving cancer therapy were studied prospectively for hepatitis reactivation and hepatitis flare. 50 patients had hematologic malignancies and 50 had solid tumours. Reactivation was defined as an increase of HCV-RNA by more than one log10 and flare was defined as increase of ALT to more than three times the upper limit of normal. 18 patients with hematologic malignancies (36 %) and 5 patients with solid tumours had reactivation during therapy. Of the 23 patients with reactivation, 10 (43 %) also had a flare. 14 patients required dose reduction or discontinuation of cancer therapy due to hepatitis flare. Among those with hepatitis reactivation 6/23 (26 %) required dose reduction/discontinuation compared to 8/77 (10 %) without hepatitis reactivation. Rituximab and high dose corticosteroids were statistically significantly associated with reactivation in a multivariable analysis. No patient with reactivation experienced liver failure or liver associated death within 36 weeks. The authors conclude that hepatitis C infection should not contraindicate cancer therapy although close monitoring is recommended.

Torres et al. Hepatology 2017;Published online 13 November, DOI: 10.1002/ hep.29344

Comment: It is reassuring that no liver failures or liver related deaths were observed in cancer therapy in hepatitis C infected patients. Even though we have extremely effective therapies for hepatitis C available, cancer therapy cannot be postponed until patients have been treated for hepatitis C and simultaneous treatment for cancer and hepatitis C is not an option.