The risk of early occurrence and recurrence of hepatocellular carcinoma in hepatitis C‐infected patients treated with direct‐acting antivirals with and without pegylated interferon: A Belgian experience

Bielen, Rob; Moreno, Christophe; Vlierberghe, Hans Van; Bourgeois, Stefan; Mulkay, Jean-Pierre; Vanwolleghem, Thomas; Verlinden, Wim; Brixco, C.; Decaestecker, Jochen; Galocsy, Chantal de; Janssens, Filip; Overbeke, Lode Van; Steenkiste, Christophe Van; D’Heygere, F; Cool, Mike; Wuyckens, K.; Nevens, Frederik; Robaeys, Geert

doi:10.1111/jvh.12726

Cited by 42 publications

(27 citation statements)

References 41 publications

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“… 51 Studies comparing the occurrence of HCC in patients taking a DAA with or without IFN also showed no significant differences. 52 Similar observations were made in another study reported from a single USA center. 53 Data on recurrence of HCC after treatment with DAAs is also conflicting, with higher rates of up to 35% in some studies 54 and no difference compared to untreated patients in other studies.…”

Section: Impact Of Newer Daa Therapies On Hccsupporting

confidence: 86%

Hepatitis C Virus and Hepatocellular Carcinoma: A Narrative Review

Axley

Ahmed

Ravi

et al. 2017

Journal of Clinical and Translational Hepatology

170

140

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Hepatocellular carcinoma (HCC) is a leading cause of liver-related death worldwide. Hepatitis C virus (HCV) infection is a major cause of advanced hepatic fibrosis and cirrhosis, with significantly increased risk for development of HCC. The morbidity and mortality of HCV-related HCC remains high, as rates of HCV cirrhosis continue to increase. The long-term goal of antiviral therapy for chronic HCV is to reduce complications from cirrhosis, including HCC. The advent of new direct-acting antivirals with high rates of virological clearance has revolutionized cure of HCV infection. While the development of HCC in HCV patients who achieve disease sustained virologic response is reduced, these patients remain at risk for HCC, particularly those patients with advanced fibrosis and cirrhosis. This review outlines the epidemiology of HCC in chronic HCV, various mechanisms, risk factors and pathophysiology that contribute to this disease process, screening recommendations, and the available data on the impact of new direct-acting antiviral treatment on the development on HCC.

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Section: Impact Of Newer Daa Therapies On Hccsupporting

confidence: 86%

Hepatitis C Virus and Hepatocellular Carcinoma: A Narrative Review

Axley

Ahmed

Ravi

et al. 2017

Journal of Clinical and Translational Hepatology

170

140

View full text Add to dashboard Cite

show abstract

“…Despite the lower rate of occurrence after DAA treatment found in a cohort examined by Bielen et al[ 29 ], there was a high early recurrence rate of HCC (15%) within 6 mo after DAA treatment. In contrast, with a report by Yang et al[ 41 ], patients with HCC recurrence had a lower SVR rate.…”

Section: Hcv-daa and Hcc Recurrencementioning

confidence: 76%

“…A major finding from this study was that upon adjusting for these differences, the risk of HCC that was associated with IFN-free regimens was similar to the risk related to INF regimens[ 28 ]. Furthermore, Bielen et al[ 29 ] did not find higher-than-expected early occurrence rates of HCC in patients treated with DAA regimens (1.1%; 4/355) compared to patients treated with IFN regimens (1.7%; 1/59). These rates were comparable to the estimated 1% per year frequency of HCC that is observed in patients with an SVR who were treated with IFN and ribavirin dual therapy.…”

Section: Hcv-daa and Hcc Occurrencementioning

confidence: 95%

Direct-acting antivirals and hepatocellular carcinoma in chronic hepatitis C: A few lights and many shadows

Guarino¹,

Sessa²,

Cossiga³

et al. 2018

WJG

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With the introduction of direct-acting antiviral agents (DAA), the rate of sustained virological response (SVR) in the treatment of hepatitis C virus (HCV) has radically improved to over 95%. Robust scientific evidence supports a beneficial role of SVR after interferon therapy in the progression of cirrhosis, resulting in a decreased incidence of hepatocellular carcinoma (HCC). However, a debate on the impact of DAAs on the development of HCC is ongoing. This review aimed to analyse the scientific literature regarding the risk of HCC in terms of its recurrence and occurrence after the use of DAAs to eradicate HCV infection. Among 11 studies examining HCC occurrence, the de novo incidence rate ranged from 0 to 7.4% (maximum follow-up: 18 mo). Among 18 studies regarding HCC recurrence, the rate ranged from 0 to 54.4% (maximum “not well-defined” follow-up: 32 mo). This review highlights the major difficulties in interpreting data and reconciling the results of the included studies. These difficulties include heterogeneous cohorts, potential misclassifications of HCC prior to DAA therapy, the absence of an adequate control group, short follow-up times and different kinds of follow-up. Moreover, no clinical feature-based scoring system accounts for the molecular characteristics and pathobiology of the tumours. Nonetheless, this review does not suggest that there is a higher rate of de novo HCC occurrence or recurrence after DAA therapy in patients with previous HCV infection.

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“…Since these early studies, many cohort studies have been conducted to analyze this issue ( Table 1 ). Of the 14 published studies available as of 1 June 2018, four concluded that there was an increased risk of HCC recurrence after DAA treatment [ 60 , 77 , 80 , 81 ] while the other 10 did not conclude in an increased risk, the recurrence rate being compared or not to a control group according to the study design [ 79 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 ].…”

Section: Beneficial Effects Of Hcv Treatmentmentioning

confidence: 99%

Epidemiology and Elimination of HCV-Related Liver Disease

Pradat

Virlogeux

Trépo

2018

Viruses

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Hepatitis C virus (HCV) infection, defined by active carriage of HCV RNA, affects nearly 1.0% of the worldwide population. The main risk factors include unsafe injection drug use and iatrogenic infections. Chronic HCV infection can promote liver damage, cirrhosis and hepatocellular carcinoma (HCC) in affected individuals. The advent of new second-generation, direct-acting antiviral (DAA) agents allow a virological cure in more than 90% of treated patients, and therefore prevent HCV-related complications. Recently, concerns have been raised regarding the safety of DAA-regimens in cirrhotic patients with respect to the occurrence and the recurrence of HCC. Here, we review the current available data on HCV epidemiology, the beneficial effects of therapy, and discuss the recent controversy with respect to the potential link with liver cancer. We also highlight the challenges that have to be overcome to achieve the ambitious World Health Organization objective of HCV eradication by 2030.

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The risk of early occurrence and recurrence of hepatocellular carcinoma in hepatitis C‐infected patients treated with direct‐acting antivirals with and without pegylated interferon: A Belgian experience

Abstract: Introduction

Cited by 42 publications

References 41 publications

Hepatitis C Virus and Hepatocellular Carcinoma: A Narrative Review

Hepatitis C Virus and Hepatocellular Carcinoma: A Narrative Review

Direct-acting antivirals and hepatocellular carcinoma in chronic hepatitis C: A few lights and many shadows

Epidemiology and Elimination of HCV-Related Liver Disease

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