Is early recurrence of hepatocellular carcinoma in HCV cirrhotic patients affected by treatment with direct‐acting antivirals? A prospective multicentre study

Cabibbo, Giuseppe; Petta, Salvatore; Calvaruso, Vincenza; Cacciola, Irene; Mr, Cannavò; Madonia, Salvatore; Distefano, Marco; Larocca, Licia; Prestileo, Tullio; Tinè, Fabio; Bertino, Gaetano; Giannitrapani, Lydia; Benanti, F.; Licata, Anna; Scalisi, I.; Mazzola, Giovanni; Cartabellotta, F.; Alessi, Nicola; Barbàra, Marco; Russello, Maurizio; Scifo, G.; Squadrito, Giovanni; Raimondo, Giovanni; Craxı̀, Antonio; Marco, Vito Di; Cammà, Calogero

doi:10.1111/apt.14256

Cited by 138 publications

(143 citation statements)

References 23 publications

(56 reference statements)

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“…HCC recurred in seven patients (2.2%). Other recently published studies did not find any increased risk of recurrent HCC with DAA . In a metaanalysis including 17 studies (2352 patients) on HCC recurrence following DAA therapy in patients with chronic HCV who received curative HCC treatment (IFN = 7, DAA = 10; prospective = 11, retrospective = 5, retrospective‐prospective = 1), DAA therapy was not associated with higher rate of HCC recurrence (RR 0.62; 95% CI 0.11‐3.45, P = .56) .…”

Section: Daa and The Risk Of Hccmentioning

confidence: 83%

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The impact of treatment of hepatitis C with DAAs on the occurrence of HCC

Roche

Coilly

Duclos-Vallée

et al. 2018

Liver International

117

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Hepatitis C virus infection is a major cause of chronic hepatitis resulting in cirrhosis and hepatocellular carcinoma (HCC). The recent introduction of direct acting antivirals (DAA), results in sustained virological response (SVR) rates of >90% in treated patients whatever the stage of liver fibrosis with an excellent safety profile. This major advancement has allowed treatment of a larger number of patients, some with more advanced liver dysfunction and a higher risk of HCC. An SVR is associated with a reduced risk of hepatic decompensation, the need for liver transplantation and both liver-related and overall mortality. This high rate of SVR has raised hopes that there would be a significant reduction in the incidence of HCC. However, the impact of DAA-based regimens on the occurrence of HCC in patients with cirrhosis, and in particular the recurrence of HCC following successful curative treatment is controversial.Published studies suggest that DAA does not increase the risk of de novo HCC following SVR. A more controversial topic is the effect of a DAA-based SVR on the recurrence of HCC following curative treatment of early HCC. Well-designed studies with robust comparisons are needed to determine the effect of DAA on the recurrence of HCC. At present, patients with HCV cirrhosis who have undergone resection or ablation for HCC should not be dissuaded from receiving DAA therapy to prevent the progression of liver disease. Monitoring for HCC with liver imaging and AFP should be performed twice a year indefinitely post-SVR in patients with HCV cirrhosis. K E Y W O R D Scirrhosis, direct acting antivirals, hepatitis C, hepatocellular carcinoma

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Section: Daa and The Risk Of Hccmentioning

confidence: 83%

“…There are no recommendations for adjuvant therapies in clinical practice guidelines . Data are also limited on DAA regimens (Table ) …”

Section: Daa and The Risk Of Hccmentioning

confidence: 99%

The impact of treatment of hepatitis C with DAAs on the occurrence of HCC

Roche

Coilly

Duclos-Vallée

et al. 2018

Liver International

117

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“…Population studies identified HCC risk factors in patients who have achieved SVR as genotype 3, advanced fibrosis, diabetes, male gender and age . A prospective multicenter study by Cabibbo et al observed that HCV‐HCC patients successfully HCC treatment via chemoembolization, ablation, or resection who were subsequently treated with DAAs and achieved SVR had 6‐, 12‐ and 18‐month HCC recurrence rates of 12%, 26.6% and 29.1%, respectively. Therefore, while the total number of patients with HCV listed for transplant is decreasing, we are not observing the same magnitude of effect on the HCV‐HCC population on the transplant list due to HCC still being a prevalent morbidity in HCV patients in spite of achieving SVR.…”

Section: Discussionmentioning

confidence: 99%

Improved liver transplant waitlist mortality and lower risk of disease progression among chronic hepatitis C patients awaiting liver transplantation after the introduction of direct‐acting antiviral therapies in the United States

Young

Liu

Bhuket

et al. 2018

Journal of Viral Hepatitis

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Summary Direct‐acting antiviral (DAA) therapies for chronic hepatitis C virus (HCV) infection achieve high cure rates, reducing HCV‐related disease progression to cirrhosis and hepatocellular carcinoma. We aim to evaluate the impact of DAAs on US liver transplant (LT) waitlist outcomes. We retrospectively evaluated US adults (age ≥18) with and without chronic HCV listed for LT before and after the widespread use of sofosbuvir, allowing a 6‐month period after approval (Era 1: 1/1/2002‐5/31/2014 vs Era 2: 6/1/2014‐12/31/2016) using the United Network for Organ Sharing registry. Overall, LT waitlist survival and likelihood of receiving LT were evaluated with multivariate Cox regression models. From 2002 to 2016, 158 045 patients were listed for LT. While the number of patients listed for HCV has been decreasing since 2012, the proportion of HCV patients with concurrent HCC is increasing by 3.33% per year (R2: 0.99, P < 0.001 by simple linear regression). While there was no difference in likelihood of LT between HCV and non‐HCV patients, those listed in Era 2 had lower likelihood of LT (HR: 0.91, P < 0.001), more pronounced in the HCV cohort (HR: 0.83, P < 0.001) compared to the non‐HCV cohort (HR: 0.93, P < 0.001). Compared to non‐HCV patients, higher waitlist mortality was seen in HCV patients in Era 1 (HR: 1.08, P < 0.001) but not in Era 2 (HR: 1.02, P = 0.75). Since the introduction of DAAs for HCV treatment, number of patients with HCV listed for LT has declined. In the post‐DAA era, HCV patients on the LT waitlist had improved waitlist mortality.

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“…A prospective multicenter study by Cabibbo et al, (58) and a retrospective cohort by Huang et al, (56) also showed the risk of HCC recurrence was not higher than that of observed in DAA -unexposed patients. Ikeda et al, even suggested that DAA therapy significantly decreased recurrence rate after adjustment with covariates of tumor multiplicity, alpha -fetoprotein (AFP) value, and prothrombin time on the basis of a multivariate analysis (59).…”

Section: "Hcc Recurrence" In Daa -Treated Patientsmentioning

confidence: 88%

Hepatitis C Virus - Related Hepatocellular Carcinoma in the Era of Direct - Acting Antiviral Agents

Gao

Niu

2018

Hepat Mon

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Context: The emergence of direct -acting antiviral agents (DAAs) with high sustained virological responses (SVR) is an epoch -making revolution. However, the value of antiviral agents in the field of hepatitis C -related hepatocellular carcinoma (HCC) is not clear. Further, the risk of tumor occurrence or recurrence following an antiviral regimen is not yet reached a consensus. Evidence Acquisition: All scientific evidence was collected through a systematic review of studies discussing DAA regimen and hepatitis C-related HCC, in PubMed, EMBASE, and Web of Science. The relevant articles were obtained and reviewed carefully before working on the paper. Results: The current review study aimed at discussing recent studies on hepatitis C -related HCC in the era of DAAs, including application of DAAs in the field of treatment of hepatitis C virus (HCV), efficacy of DAAs on HCV-associated HCC, and the effect of DAAs on occurrence and recurrence of HCC. Conclusions: It was shown that DAAs had a relatively poor therapeutic effect on HCV patients with HCC, based on the current studies. After analyzing the existing data, the conclusion cannot yet be reached that DAA treatment influences the risk of HCC in patients with HCV infection.

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Is early recurrence of hepatocellular carcinoma in HCV cirrhotic patients affected by treatment with direct‐acting antivirals? A prospective multicentre study

Cited by 138 publications

References 23 publications

The impact of treatment of hepatitis C with DAAs on the occurrence of HCC

The impact of treatment of hepatitis C with DAAs on the occurrence of HCC

Improved liver transplant waitlist mortality and lower risk of disease progression among chronic hepatitis C patients awaiting liver transplantation after the introduction of direct‐acting antiviral therapies in the United States

Hepatitis C Virus - Related Hepatocellular Carcinoma in the Era of Direct - Acting Antiviral Agents

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