Hepatitis C virus (HCV) reactivation occurs in 23% of HCV-infected
cancer patients receiving
chemotherapy. Forty-three percent of the patients with reactivation of HCV during
chemotherapy develop a
hepatitis flare. Most of the
cancer patients with HCV reactivation have an unremarkable
clinical course following an HCV-related
hepatitis flare during
chemotherapy. However, 26%-57% of the
cancer patients developing an acute flare of
chronic hepatitis C during
chemotherapy require unanticipated discontinuation or
dose reduction of
chemotherapy, which results in deleterious changes in the
cancer treatment plan. Although an optimal strategy for HCV screening in
cancer patients receiving
chemotherapy has not been established, universal pre-
chemotherapy HCV testing for patients with
hematological malignancies is recommended by current guidelines. All the currently approved direct-acting
antivirals (DAAs) can be used in
cancer patients, but the use of DAAs during
chemotherapy should avoid drug-drug interactions between
chemotherapy and
antiviral agents. If there are no
contraindications or anticipated drug-drug interactions, DAAs treatment can be administered before, during, or after
chemotherapy. In conclusion, HCV reactivation occurs in approximately one-fourth of HCV-infected
cancer patients receiving
chemotherapy. An HCV-related
hepatitis flare during
chemotherapy may lead to the discontinuation of potentially life-saving
chemotherapy. Currently, universal HCV screening is recommended in
hematological malignancy patients before
chemotherapy, but there is no evidence-based guideline for other
cancer patients. DAAs treatment can cure HCV
infection and prevent HCV reactivation during
chemotherapy.