Torres Harrys A, Shigle Terri Lynn, Hammoudi Nassim, Link James T, Samaniego Felipe, Kaseb Ahmed, Mallet Vincent
Associate Professor, Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX.
Clinical Pharmacy Specialist, Division of Pharmacy, Section of Clinical Pharmacy Services, The University of Texas MD Anderson Cancer Center, Houston, TX.
CA Cancer J Clin. 2017 Sep;67(5):411-431. doi: 10.3322/caac.21403. Epub 2017 Jul 6.
Answer questions and earn CME/CNE Chronic hepatitis C virus (HCV) infection affects millions of people worldwide and is associated with cancer. Direct-acting antivirals (DAAs) have changed HCV treatment paradigms, but little is known about the management of HCV infection in patients with cancer. The substantial burden of HCV infection and the inconclusive evidence regarding its detection and management in patients with cancer prompted the authors to review the literature and formulate recommendations. Patients for whom HCV screening is recommended included all patients with hematologic malignancies, hematopoietic cell transplantation candidates, and patients with liver cancer. There is a lack of consensus-based recommendations for the identification of HCV-infected patients with other types of cancer, but physicians may at least consider screening patients who belong to groups at heightened risk of HCV infection, including those born during 1945 through 1965 and those at high risk for infection. Patients with evidence of HCV infection should be assessed by an expert to evaluate liver disease severity, comorbidities associated with HCV infection, and treatment opportunities. DAA therapy should be tailored on the basis of patient prognosis, type of cancer, cancer treatment plan, and hepatic and virologic parameters. HCV-infected patients with cancer who have cirrhosis (or even advanced fibrosis) and those at risk for liver disease progression, especially patients with HCV-associated comorbidities, should have ongoing follow-up, regardless of whether there is a sustained virologic response, to ensure timely detection and treatment of hepatocellular carcinoma. HCV infection and its treatment should not be considered contraindications to cancer treatment and should not delay the initiation of an urgent cancer therapy. CA Cancer J Clin 2017. © 2017 American Cancer Society. CA Cancer J Clin 2017;67:411-431. © 2017 American Cancer Society.
回答问题并获取继续医学教育/护理继续教育学时 慢性丙型肝炎病毒（HCV）感染影响着全球数百万人，且与癌症相关。直接抗病毒药物（DAA）改变了HCV的治疗模式，但对于癌症患者中HCV感染的管理却知之甚少。HCV感染的沉重负担以及关于其在癌症患者中的检测和管理的不确定证据促使作者回顾文献并制定建议。建议进行HCV筛查的患者包括所有血液系统恶性肿瘤患者、造血干细胞移植候选者以及肝癌患者。对于识别其他类型癌症的HCV感染患者，缺乏基于共识的建议，但医生至少可以考虑对属于HCV感染高风险群体的患者进行筛查，包括1945年至1965年出生的人群以及感染高风险人群。有HCV感染证据的患者应由专家进行评估，以评估肝病严重程度、与HCV感染相关的合并症以及治疗机会。DAA治疗应根据患者预后、癌症类型、癌症治疗计划以及肝脏和病毒学参数进行调整。患有肝硬化（甚至是晚期纤维化）的癌症HCV感染患者以及有肝病进展风险的患者，尤其是患有HCV相关合并症的患者，无论是否有持续病毒学应答，都应进行持续随访，以确保及时检测和治疗肝细胞癌。HCV感染及其治疗不应被视为癌症治疗的禁忌证，也不应延迟紧急癌症治疗的启动。《CA：临床医师癌症杂志》2017年。©2017美国癌症协会。《CA：临床医师癌症杂志》2017；67：411 - 431。©2017美国癌症协会。
