David L. Ramirez

American Society of Clinical Oncology guidelines recommend screening all patients for hepatitis B virus (HBV) and hepatitis C virus (HCV) before initiation of cancer therapy. Cancer patients receiving cancer therapy represent a vulnerable population, and reactivation of undetected hepatitis virus can lead to devastating consequences. At MD Anderson Cancer Center, rates of hepatitis screening for all cancer patients have been historically low. The overall aim of this quality improvement (QI) study was to increase rates of HBV and HCV screening to at least 50% in early-stage breast cancer patients before cancer therapy in the Breast Medical Oncology clinic at MD Anderson. The present study reports current progress after the first QI cycle. QI measures were implemented by 1) creation of an order panel in the electronic medical record (EMR) that contains all tests needed for comprehensive HBV and HCV screening and 2) an educational session to providers in the Breast Medical Oncology clinics. Data were collected for patients seen at MD Anderson initiating cancer therapy (start of cycle 1) from April 1, 2023, through September 30, 2023, which was immediately after the QI initiatives were implemented. Inclusion criteria were early-stage breast cancer (stage I-III) and receiving chemotherapy at MD Anderson. Of 340 patients screened, 220 met the inclusion criteria for data extraction. In total, 105 patients (48%) received comprehensive HBV screening (measuring HBV surface antigen [HBsAg], HBV core antibody [anti-HBc], and antibody to HBV surface antigen [anti-HBs]), and 137 (63%) received at least 1 HBV test. A total of 122 (56%) patients were screened for HCV. Eighty-eight patients (40%) received both comprehensive HBV and HCV screening. The EMR order panel was used in 51 (23%) of patients. Anti-HBc was positive in 8 of those tested, and HBsAg was positive in 1 patient. No patients tested positive for HCV. Screening rates for HBV and HCV individually were near or exceeded our goal; however, rates of combined HBV and HCV screening were lower. Going forward, additional education to providers as well as increased use of the available order panel will be needed to ensure we are comprehensively screening for both HBV and HCV in our patients.

Type of Surgery and Adjuvant Therapy Received.

Somatic mutations identified by whole exome sequencing. Oncoplot representing the most common somatic mutations assessed by whole exome sequencing (WES) in tumors obtained from patients (n = 23) at the time of diagnosis. Genes with mutations occurring in five or more patients are shown.

Representativeness of Study Participants.

SUPPLEMENTARY FIGURE SF3. Box plots showing relationship between tumor mutational burden and pathological response.

Molecular Subtypes and Pathological Response.

SUPPLEMENTARY FIGURE SF2. Somatic mutations in genes commonly altered in TNBC. Oncoplot showing somatic mutations reported as commonly prevalent in other TNBC cohorts.

SUPPLEMENTARY FIGURE SF2. Somatic mutations in genes commonly altered in TNBC. Oncoplot showing somatic mutations reported as commonly prevalent in other TNBC cohorts.

Table 2 from Targeting the Epidermal Growth Factor Receptor Pathway in Chemotherapy-Resistant Triple-Negative Breast Cancer: A Phase II Study

Survival outcomes. A, Kaplan–Meier plot of EFS for all patients. B, Kaplan–Meier plot of EFS separated by pathological response. C, Kaplan–Meier plot of MFS for all patients. D, Kaplan–Meier plot of MFS separated by pathological response. E, Kaplan–Meier plot of OS for all patients. F, Kaplan–Meier plot of OS separated by pathological response.