Abstract 1888P
Background
SACT can cause reactivation of Hepatitis B virus (HBVr) in patients with prior HBV, with a risk of treatment interruption, liver failure or death. Ireland is classified as a low endemic area for HBV (Hepatitis B surface antigen (HbSAg) prevalence: 0.43%, Hepatitis B core antibody (antiHBc): 1.7%). ESMO recommends screening patients (pts) for HBV infection before starting SACT and prophylaxis as appropriate. In 2014, we found a 5.6% rate of prior infection in our pts. We aimed to reassess screening completeness, and to estimate the prevalence of HBV among our current pts.
Methods
‘Complete screening’ was defined as HbSAg, antiHBc & HepCAb tests within 90 days of the proposed start of a new SACT line. We retrospectively reviewed screening between 1/9/19 and 30/11/19 (phase I (P1), n=288). After staff education, screening was re-audited over two weeks in April 2020, (phase II (P2), n=164).
Results
Of all pts, 76.8% had a complete panel at some point. 14.2% never had any viral serology. Breast cancer patients had the highest ‘never-screened’ risk (26.4%, p<0.05, OR 3.3, 95% CI 1.9-5.8). After lymphoma patients, they were the most likely to receive high-risk treatments for HBVr (23%, p<0.01, OR 3.9, 95% CI 2.1-6.9). P2 occurred during the COVID-19 pandemic. Age range (median 63.3/59.4 years in P1/P2), gender balance (42.6/45.5% male), proportion with metastatic disease (51.6/58.3%) or on 1st line therapy (58.8/68.1%) were similar in P1 and P2. P2 patients were less likely to receive therapy at medium/high-risk for HBVr (p<0.001, OR 0.11, 95% CI 0.07-0.19). Complete screening showed a non-significant increase, from 49.8% in P1 to 58.3% in P2 (p=0.051, OR 1.41, 95% CI 0.96-2.07). Screening in lymphoma (41.7% to 90.9%, p<0.03, OR 3.3, 95% CI 1.1-9.9) and skin cancer pts (14.3% to 71.4%, p<0.03, OR 7.9, 95% CI 0.3-69.1) did improve. 1 patient (0.26%) was positive for HbSAg and 14 (4.03%) for antiHBc. Of the antiHBc positive patients, 8 were given prophylactic entecavir and 3 lamivudine. 2 died shortly after screening and did not begin prophylaxis or SACT. No pt had evidence of HBVr.
Conclusions
The rate of rate of HBV positivity was comparable to 2014 and higher than national estimates, justifying ESMO guidelines. Further education is needed to improve screening.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.