Among Cirrhotic Patients with a Hepatitis C Sustained Viral Response, the Risk of De-novo Hepatocellular Carcinoma Relates to Baseline Factors and Not the Use of Direct Acting Antivirals: Results from a Nationwide Cohort

Innes, Hamish; Barclay, Stephen T.; Hayes, PC; Fraser, Andrew; Dillon, John F.; Stanley, Abigail; Bathgate, Andrew; McDonald, Sarah E.; Goldberg, D.; Valerio, Heather; Fox, Richard; Kennedy, N.; Bramley, Peter; Hutchinson, Sharon J.

doi:10.1016/s0168-8278(17)30306-9

Cited by 17 publications

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“…However, in a prospective study from England, the investigators showed a reduction in liver cancer rates from 4% in 261 untreated patients over 6 months to 1.9% over 9 months after achieving viral clearance in 317 successfully treated patients [17]. A study from Scotland demonstrated that the risk of HCC following SVR relates to the baseline risk factors and not to the use of DAAs [18].…”

Section: The Impact Of Ifn-free Regimens On Hcc Occurrencementioning

confidence: 99%

Hepatocellular Carcinoma Occurrence and Recurrence after Antiviral Treatment in HCV-Related Cirrhosis. Are Outcomes Different after Direct Antiviral Agents? A Review

Spârchez

Mocan²

2017

JGLD

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Hepatitis C virus (HCV) infection is one of the major causes of hepatocellular carcinoma (HCC) worldwide. In the last decades, several studies have showed a lower rate of HCC occurrence or recurrence in patients with HCV-related cirrhosis after interferon-based antiviral therapies compared to untreated controls, even without reaching viral clearance. Unfortunately, interferon regimens could only yield viral clearance in approximately half of the patients. The recent development of new all-oral regimens with direct-acting antivirals (DAAs) has radically improved the cure rate to above 90%. In respect to these findings, many would have thought that interferon-free regimens would decrease the development and recurrence of HCC. Literature data have unexpectedly reported high rates of both the occurrence and recurrence of HCC after therapy with DAAs. However, it is probably too early to express some concerns. More recent data showed that both occurrence and recurrence of HCC are decreased by the DAAs. Interferon-free therapy is definitely not without limits. Together with the initial thoughts of an increased risk of HCC, these may lead to an unwanted restricted access to interferon-free regimens in specific subpopulations. This issue should be settled as soon as possible because millions of hepatitis C patients are and will be using DAAs in the present and future. Our purpose is to review the existing literature and to offer a more precise and rational interpretation of the existing data.Key words: – – e – .Abreviations: AFP: alpha-fetoprotein; DAA: direct antiviral agent; HCC: hepatocellular carcinoma; HCV: hepatitis C virus; HR: hazard ratio; IFN: interferon; LDV: Ledispavir; SMV: Simeprevir; SOF: Sofosbuvir; SVR: sustained virologic response.

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Section: The Impact Of Ifn-free Regimens On Hcc Occurrencementioning

confidence: 99%

Hepatocellular Carcinoma Occurrence and Recurrence after Antiviral Treatment in HCV-Related Cirrhosis. Are Outcomes Different after Direct Antiviral Agents? A Review

Spârchez

Mocan²

2017

JGLD

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“…Mitigating the concern raised by these reports, however, was the perception of a potential referral bias stemming from the retrospective design of studies and the parallel publication of more than one study from different geographical regions, including a large multicenter ARNS study in France, that provided opposite interpretation regarding the risk of HCC occurrence and recurrence after DAA therapy. In more than one study, a relationship was demonstrated between HCC occurrence following DAA therapy, duration of the post‐treatment surveillance period, patient age and severity of the liver impairment (Table ).…”

Section: Recent Data Summarised In This Table Suggest a Relationship mentioning

confidence: 99%

Hepatitis C virus eradication with direct antiviral agents and liver cancer recurrence: Is the best the enemy of the good?

Colombo¹,

Bruno

Lleo

2017

Liver International

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Hepatocellular carcinoma after direct‐acting antiviral drug treatment in patients with hepatitis C virus

et al. 2018

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Background and Aim Given the use of direct‐acting antivirals (DAAs) to treat hepatitis C virus (HCV), their effects on hepatocarcinogenesis should be determined. Methods This study enrolled 349 patients with HCV who underwent DAA treatment at our hospital between 2014 and 2018. Their median age was 65 years, and 184 were male; 301 cases were of HCV serotype 1, and 48 were of serotype 2. The DAA treatment was daclatasvir/asunaprevir in 107 cases, sofosbuvir (SOF)/ledipasvir in 147 cases, ritonavir‐boosted ombitasvir/paritaprevir in 28 cases, elbasvir/grazoprevir in 19 cases, and SOF/ribavirin in 48 cases. The patients’ histories included hepatocellular carcinoma (HCC) in 45 cases, liver transplant (LT) in 10 cases, and kidney transplant (KT) in 17 cases. Results Sustained virological responses occurred in 335 cases (96%). DAA treatment was initiated a median of 16.3 months after HCC treatment. After DAA treatment, 15 cases (33%) had recurrence of HCC after a median of 11.6 months, and 3 cases (1%) developed de novo HCC. Six LT patients and one KT patient had HCC; however, no HCC was observed after DAA. The incidence of HCC was significantly higher in patients with multiple HCC treatments in the Cox hazard model (hazard ratio 1.664, 95% confidence interval 1.134–2.441, P < 0.01). Surgical resection or LT reduced the risk of HCC. Conclusions DAA did not increase the rate of HCC, even in immunosuppressed patients. However, careful follow‐up for HCC recurrence is required in previously treated cases.

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Among Cirrhotic Patients with a Hepatitis C Sustained Viral Response, the Risk of De-novo Hepatocellular Carcinoma Relates to Baseline Factors and Not the Use of Direct Acting Antivirals: Results from a Nationwide Cohort

Cited by 17 publications

References 0 publications

Hepatocellular Carcinoma Occurrence and Recurrence after Antiviral Treatment in HCV-Related Cirrhosis. Are Outcomes Different after Direct Antiviral Agents? A Review

Hepatocellular Carcinoma Occurrence and Recurrence after Antiviral Treatment in HCV-Related Cirrhosis. Are Outcomes Different after Direct Antiviral Agents? A Review

Hepatitis C virus eradication with direct antiviral agents and liver cancer recurrence: Is the best the enemy of the good?

Hepatocellular carcinoma after direct‐acting antiviral drug treatment in patients with hepatitis C virus

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