# Hepatitis C Management in a Lung Cancer Patient on Checkpoint Inhibition: A Case Report

## TL;DR

This case report describes managing hepatitis C in a lung cancer patient undergoing immunotherapy and chemotherapy.

## Contribution

The paper presents a novel case of treating hepatitis C alongside cancer therapy and reviews HCV management in cancer patients.

## Key findings

- A lung cancer patient successfully treated for newly diagnosed hepatitis C before starting cancer therapy.
- Checkpoint inhibitors and chemotherapy can increase the risk of hepatitis C reactivation or disease flare.
- There is a lack of clinical guidelines for managing hepatitis C in cancer patients.

## Abstract

Direct-acting antivirals (DAAs) have fundamentally changed the paradigm of chronic hepatitis C treatment, and their use is now recommended for all patients with active infection. Immunosuppression is a known contributing factor to an increased risk of disease progression, necroinflammatory activity, and chronic liver disease in individuals with chronic viral hepatitis, including both hepatitis B and C. Viral reactivation or flares of disease activity have been described in patients with chronic hepatitis B or C, respectively, who undergo immunosuppressive or immunomodulatory treatments, including chemotherapy and immunotherapy with checkpoint inhibitors. However, there is a paucity of guidance regarding the treatment of chronic hepatitis C in patients with cancer, and this population has traditionally been excluded from clinical trials. We report the clinical case of a 56-year-old male undergoing chemotherapy and immunotherapy for stage IVA lung adenocarcinoma and the successful treatment of a newly diagnosed hepatitis C infection, which was identified immediately before the onset of cancer treatment. We also provide a review of key aspects of hepatitis C screening and recent advances in hepatitis C virus (HCV) management among cancer patients.