skip to main content

HBV Reactivation vs ICI Hepatitis — SCE Medical Oncology MCQ

Instant feedback + full explanation. One question, done properly.

HardImmunotherapy & Targeted TherapyHBV Reactivation vs ICI HepatitisSCE Medical Oncology

A 68-year-old man with advanced oesophageal cancer on immunotherapy develops immune-related hepatitis. He also has chronic hepatitis B (HBsAg positive, on entecavir suppressive therapy). His hepatologist is concerned about HBV reactivation vs ICI hepatitis. How can these be distinguished?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Monitor HBV DNA and ALT throughout antiviral suppression

A rising HBV DNA level identifies virological reactivation, whereas ALT alone cannot distinguish reactivation from immune-mediated hepatitis; serial HBV DNA and ALT should therefore be followed with hepatology input while antiviral suppression continues. HBsAg is already positive and does not quantify replication. Anti-HBs does not monitor replication in an HBsAg-positive patient. HBeAb is not a substitute for viral load. Alpha-fetoprotein is a tumour marker and does not diagnose HBV reactivation.

Reference: AGA clinical practice guideline on prevention and treatment of hepatitis-B reactivation (Published March 2025): https://pubmed.ncbi.nlm.nih.gov/39863345/; West of Scotland Cancer Network immune-related adverse-events guideline (Version 4.0, March 2024; review due March 2027): https://rightdecisions.scot.nhs.uk/media/b11eeh40/woscan-immunotherapy-iraes-guideline-v40.pdf