Effects of antiviral therapy on hepatitis B virus reactivation and liver function after resection or chemoembolization for hepatocellular carcinoma

Lao, Xiang-Ming; Luo, Guangyu; Ye, Liang Tao; Luo, Cheng; Shi, Ming; Wang, Dian; Guo, Rong; Chen, Minshan; Li, Shengping; Lin, Xiaojun; Yuan, Yunfei

doi:10.1111/liv.12112

Cited by 85 publications

(105 citation statements)

References 29 publications

(44 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A retrospective study involving 590 HCC patients who were HBV surface antigen-positive and accepted either surgical resection or TACE showed that the HBV-reactivation rate in TACE treatment was 1.5% with antiviral therapy and 17.5% without anti-HBV therapy. The rate of deterioration of liver function was much lower in the anti-HBV therapy (1.5% vs. 8.1%) (47). In 2014, a prospectiveretrospective study of 404 HBV-related HCC patients with hepatectomy showed that antiviral therapy improved the survival and liver function reserved at the time of recurrence.…”

Section: Anti-virus Therapymentioning

confidence: 99%

Systemic therapies for hepatocellular carcinoma

Huang

2015

DD&T

View full text Add to dashboard Cite

Section: Anti-virus Therapymentioning

confidence: 99%

Systemic therapies for hepatocellular carcinoma

Huang

2015

DD&T

View full text Add to dashboard Cite

“…Lamivudine therapy rapidly suppressed HBV DNA load and improved the Child-Pugh score in patients with decompensated cirrhosis chronically infected with HBV [41,42]. Antiviral therapy improved liver function in patients with HBV-related HCC [28,43]. Large, controlled studies should examine directly whether NA therapy provides clinical benefits to patients with Child-Pugh B or C liver function.…”

Section: What Are the Indications For Na Therapy?mentioning

confidence: 99%

“…Huang et al, the team that published one of the two RCTs on NA therapy [23], earlier investigated the risk of HBV reactivation in individuals with low serum levels of HBV DNA (<2000 IU/ mL) at the time of HR. [31] HBV reactivation occurred in 19.1 % of patients by 1 year after surgery, and rates of liver failure were significantly higher in these patients than in those who did not suffer reactivation (10.5-11.8 % vs. 2.7-6.4 %) [28,31], while 3-year RFS and OS were significantly lower [31]. Given the strong potential for HBV reactivation and the fact that persistent HBV replication increases the risk of recurrence [32], we suggest that NA therapy be initiated before HR in patients with HBV-related HCC and detectable serum levels of HBV DNA.…”

mentioning

confidence: 99%

“…This can lead to fulminant hepatitis, liver failure, or even mortality. Post-resection rates of HBV reactivation range from 16 to 28 % in patients not taking antiviral therapy [27][28][29][30], while the corresponding numbers are 0 and 2.9 % in patients taking antiviral therapy [27][28][29]. Huang et al, the team that published one of the two RCTs on NA therapy [23], earlier investigated the risk of HBV reactivation in individuals with low serum levels of HBV DNA (<2000 IU/ mL) at the time of HR.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Nucleos(t)ide analogue therapy for HBV-related HCC after hepatic resection: clinical benefits and unanswered questions

Zhong

2014

Tumor Biol.

View full text Add to dashboard Cite

Hepatic resection (HR) and radiofrequency ablation (RFA) remain the most frequent curative therapies for hepatocellular carcinoma (HCC) because of strict indications for liver transplantation and shortages of donated livers. Nevertheless, recurrence occurs in up to 75 % of patients with intermediate or advanced HCC at 5 years after HR [1]; in these patients, 5-year recurrence-free survival (RFS) is lower than 25 %, and tumor recurrence is the main cause of death [2]. Therefore, inhibiting tumor recurrence is a key to improving HCC patients' overall survival (OS).Hepatitis B virus (HBV) is the most common cause of HCC around the world, which inspired clinicians to treat patients with HBV-related HCC using nucleos(t)ide analogues (NAs) to inhibit HBV replication and therefore reduce risk of HCC incidence. High HBV load and replication are associated with greater risk of HCC incidence [3], and large studies with long follow-up have shown that NA therapy can dramatically reduce HCC incidence and death in patients with liver cirrhosis who are chronically infected with HBV [4,5]. NA therapy also appears to reduce risk of HCC recurrence after HR [6,7], suggesting that it may improve OS for patients with HBVrelated HCC after curative HR or RFA.Many retrospective studies have suggested that adjuvant NA therapy does reduce risk of HBV-related HCC recurrence after curative treatments [7][8][9][10][11][12][13][14][15][16][17][18][19]. Meta-analysis of these studies have concluded that NA therapy is associated with significantly lower tumor recurrence and liver-related mortality and significantly higher OS in patients with HBV-related HCC than no adjuvant therapy after curative treatments [20,21]. Unfortunately, the retrospective design of these studies limits the strength of their evidence. The strongest evidence of whether NA therapy offers clinical benefits would come, in principle, from a randomized controlled trial (RCT). However, carrying out an RCT is ethically and logistically difficult because oral NA therapy has already proven effective at preventing disease progression in patients chronically infected with HBV and because such therapy is becoming more affordable and does not cause significant side effects. Therefore, few patients with HBV-related HCC would volunteer for an RCT.Despite these obstacles, Yin et al. managed to publish in 2013 the first RCT examining the efficacy of adjuvant NA therapy in 180 patients newly diagnosed with HBV-related HCC after curative HR [22]. All patients had serum HBV DNA levels greater than 100 IU/mL. After median follow-up of 39.9 months, per-protocol analysis revealed that patients receiving lamivudine (100 mg/day) showed significantly higher short-and long-term RFS and OS than patients receiving no adjuvant therapy. In 2014, Huang and coworkers [23] performed an RCT examining the efficacy of adjuvant adefovir therapy in 200 patients newly diagnosed with HBVrelated HCC after curative HR. In contrast to the earlier RCT, all patients in this study had serum HBV DNA levels greater t...

show abstract

“…In general, antivirals should be administered prior to treatment of HCC once the patient is known to be a virus carrier. For HBV-related HCC, the benefit of antivirals is seen in patients treated by surgery [127] , TACE [128] or radiotherapy [129] . For HCV-related HCC, evidence is available for older generation interferonbased antivirals that they reduce tumor recurrence [130,131] .…”

Section: Etiological Adjunctive Treatment For High-burden Hccmentioning

confidence: 99%

Treatment of high-burden hepatocellular carcinoma: an oncologist perspective

Chan¹,

Chan²

2018

View full text Add to dashboard Cite

Hepatocellular carcinoma (HCC) is recognized as a major global healthcare burden. Although there have been tremendous improvements in cancer screening and treatment, HCC mortality rate remains high. Many patients with HCC present late to medical attention and thus are not candidates for curative treatment. They typically have high tumor burden at presentation showing heterogeneity in anatomical factors and biochemical profile. Despite the relatively poor prognosis for these patients, significant improvements can still be made in survival if the optimal treatment modality is chosen. Currently, there is no international consensus on how to manage this group of heterogeneous, high-burden HCC. In this article, we will address this question by reviewing the latest available evidences. Our definition of "high-burden HCC" will be based on three factors: size, number of tumors and the presence of macrovascular invasion. The different treatment modalities, namely surgery, intra-arterial therapy, radiotherapy and systemic therapy, and their respective supportive evidences, will be discussed. In the end, we will summarize with our views on the future direction of research priorities for the management of high-burden HCC.

show abstract

Effects of antiviral therapy on hepatitis B virus reactivation and liver function after resection or chemoembolization for hepatocellular carcinoma

Abstract: HBV reactivation can occur after hepatectomy or TACE. Anti-HBV therapy can reduce the risk of reactivation, thus reducing the risk of liver failure especially in patients undergoing TACE.

Cited by 85 publications

References 29 publications

Systemic therapies for hepatocellular carcinoma

Systemic therapies for hepatocellular carcinoma

Nucleos(t)ide analogue therapy for HBV-related HCC after hepatic resection: clinical benefits and unanswered questions

Treatment of high-burden hepatocellular carcinoma: an oncologist perspective

Contact Info

Product

Resources

About