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)

Abstract

tie 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.

The effect of anticancer treatment on cancer patients with COVID‐19: A systematic review and meta‐analysis

“…The elevated RR of the severe/critical rate in chemotherapy proves to support the theory. The adverse impact of cytotoxic chemotherapy on prognosis was also revealed in other viral infections 45,46 . Moreover, cytotoxic agents vary in their mechanisms and some agents were found to have anti‐CS effects, 47 which may account for the high heterogeneity of chemotherapy.…”

“…The adverse impact of cytotoxic chemotherapy on prognosis was also revealed in other viral infections. 45,46 Moreover, cytotoxic agents vary in their mechanisms and some agents were found to have anti-CS effects, 47 which may account for the high heterogeneity of chemotherapy. Targeted agents, which are highly selective to on co-molecular targets, are generally thought to cause fewer side effects.…”

Assessment of Cancer Care Costs in Disease-Specific Cancer Care Pathways

“…These efforts, however, are counterbalanced by the risk increase resulting from the population aging [ 7 , 9 ]. The standard strategy for improving cancer care while controlling the costs [ 10 , 11 , 12 , 13 ] is to promote the adherence to clinical practice guidelines [ 14 ]. A new, and promising, solution is to perform qualitative analyses of medical procedures in order to improve the uptake of research findings into practice [ 15 ] and to identify areas of low-value use of resources [ 16 ].…”