Need For HBV Cure: Persistent Risk For Subsequent New And Recurrent HCC Even After A Decade Of Successful Anti-HBV Therapy And Initial Tumor Ablation

Shinn, Brianna; Kistler, C. Andrew; Roth, Christopher; Hann, Hie Won

doi:10.21767/2254-6081.100172

Cited by 7 publications

(10 citation statements)

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“…It is important to recognize that "undetectable" is a relative term given the variation in measurements conducted by different laboratory assays. At the Liver Disease Prevention Center, Division of Gastroenterology and Hepatology of Thomas Jefferson University Hospital, long-term follow-up data has demonstrated HCC recurrence in patients even after a decade of successful viral suppression (54,55) In our observational cohort, as of October 2020, 17 patients developed HCC despite having been treated for 9-19 years (median 13 years) with undetectable HBV DNA for 3-12 years (median 8 years) (Table 1). This is among the longest known follow up studies on the development of HCC in patients taking antiviral therapy.…”

Section: Persistent Risk For Hcc Despite Successful Hbv Suppressionmentioning

confidence: 86%

Achieving a Cure: The Next Frontier in Hepatitis B Treatment

et al. 2021

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Since the discovery of the hepatitis B virus (HBV) by Blumberg et al. in 1965, significant progress has been made in understanding the pathogenesis of the virus and creating an effective vaccine. In the past two decades, several antiviral therapies have reduced the incidence of HBV-related hepatocellular carcinoma. The nucleos(t)ide analogues have succeeded in decreasing the viral load to undetectable levels but have been unable to eradicate the virus due to the persistence of covalently closed circular DNA in the hepatocyte nucleus. Despite being on successful antiviral therapy for multiple years, patients are still at risk of developing hepatocellular carcinoma. Recently, a number of different drug targets have been identified that intervene on the viral replication cycle or host immune system. This chapter discusses the immunopathogenesis of the virus, the effectiveness of nucleos(t)ide analogues, and recent therapeutic developments. In light of robust progress achieved in antiviral therapy, the cure for hepatitis B is likely on the horizon.

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Section: Persistent Risk For Hcc Despite Successful Hbv Suppressionmentioning

confidence: 86%

Achieving a Cure: The Next Frontier in Hepatitis B Treatment

et al. 2021

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“…Following successful transarterial chemoembolization (TACE) and radiofrequency ablation she was maintained on antiviral therapy for five years at which point she was found to have a 1.1 cm × 0.8 cm arterially enhancing lesion with washout appearance near the previously treatment site on abdominal magnetic resonance imaging consistent with recurrent HCC. She underwent TACE and was maintained on antiviral therapy for another ten years at which point she developed another 0.8 cm recurrent HCC despite an undetectable serum HBV DNA[18].…”

Section: Current Antiviral Therapies For Chronic Hbv and The Impact Omentioning

confidence: 99%

“…Hepatocellular carcinoma in three patients with chronic hepatitis B[18]. HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus.…”

Section: Current Antiviral Therapies For Chronic Hbv and The Impact Omentioning

confidence: 99%

“…Persistent risk for recurrent hepatocellular carcinoma in a patient with chronic hepatitis B[18]. HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; MRI: Magnetic resonance imaging; TACE: Transarterial chemoembolization; RFA: Radiofrequency ablation.…”

Section: Current Antiviral Therapies For Chronic Hbv and The Impact Omentioning

confidence: 99%

“…However, it has been reported that despite several years of antiviral therapy, a persistent risk for carcinogenesis still exists[13-15]. Studies have also demonstrated that even after more than a decade of successful HBV suppression, the risk for HBV-related HCC remains[16-18]. The aims of this minireview are to bring light to these observations and emphasize the need for a cure for HBV[19-21].…”

Section: Introductionmentioning

confidence: 99%

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Persistent risk for new, subsequent new and recurrent hepatocellular carcinoma despite successful anti-hepatitis B virus therapy and tumor ablation: The need for hepatitis B virus cure

Shinn¹,

Martin²,

Coben³

et al. 2019

WJH

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Hepatitis B virus (HBV) is one of the most significant hepatocarcinogens. The ultimate goal of anti-HBV treatment is to prevent the development of hepatocellular carcinoma (HCC). During the last two decades, with the use of currently available anti-HBV therapies (lamivudine, entecavir and tenofovir disoproxil fumatate), there has been a decrease in the incidence of HBV-associated HCC (HBV-HCC). Furthermore, several studies have demonstrated a reduction in recurrent or new HCC development after initial HCC tumor ablation. However, during an observation period spanning 10 to 20 years, several case reports have demonstrated the development of new, subsequent new and recurrent HCC even in patients with undetectable serum HBV DNA. The persistent risk for HCC is attributed to the presence of covalently closed circular DNA (cccDNA) in the hepatocyte nucleus which continues to work as a template for HBV replication. While a functional cure (loss of hepatitis B surface antigen and undetectable viral DNA) can be attained with nucleos(t)ide analogues, these therapies do not eliminate cccDNA. Of utmost importance is successful eradication of the transcriptionally active HBV cccDNA from hepatocyte nuclei which would be considered a complete cure. The unpredictable nature of HCC development in patients with chronic HBV infection shows the need for a complete cure. Continued support and encouragement for research efforts aimed at developing curative therapies is imperative. The aims of this minireview are to highlight these observations and emphasize the need for a cure for HBV.

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Timing disparity of hepatocellular carcinoma (HCC) recurrence in a patient receiving interferon and subsequent direct antiviral agent (DAA) therapy for chronic hepatitis C

Cao¹,

Halegoua-DeMarzio²,

Coben³

et al. 2020

Gastroenterol Hepatol Endosc

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The advent of direct acting antiviral (DAA) agents has redefined the treatment landscape for hepatitis C virus (HCV) within the past decade, with achievement of high HCV eradication rates.However, several reports have suggested an increased incidence of tumor recurrence following DAA treatment compared with interferon treatment. In adding to the evolving literature, we herein present a case of a 73-year-old female with long term follow up at our center, who had recurrence of previously treated HCC after 4 years and 7 months on maintenance interferon therapy and subsequent development of a new HCC after 14 months on DAA therapy. Tumor ablation consisted of successful trans-arterial chemoembolization and microwave ablation.

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Need For HBV Cure: Persistent Risk For Subsequent New And Recurrent HCC Even After A Decade Of Successful Anti-HBV Therapy And Initial Tumor Ablation

Cited by 7 publications

References 0 publications

Achieving a Cure: The Next Frontier in Hepatitis B Treatment

Achieving a Cure: The Next Frontier in Hepatitis B Treatment

Persistent risk for new, subsequent new and recurrent hepatocellular carcinoma despite successful anti-hepatitis B virus therapy and tumor ablation: The need for hepatitis B virus cure

Timing disparity of hepatocellular carcinoma (HCC) recurrence in a patient receiving interferon and subsequent direct antiviral agent (DAA) therapy for chronic hepatitis C

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