Advertisement

Spotlight Series on Hepatitis C

News

Vienna Doctors Urge Caution When Assessing Possible Associations Between Liver Cancer Recurrence and Use of DAAs

July 2016

Doctors in Vienna, Austria, recently reported a group of cases of liver cancer in 19 participants whose hepatitis C virus (HCV) was treated with direct acting antivirals (DAAs). Three of these participants had previously been diagnosed with liver cancer. Nearly all had been infected with HCV for many years and had what the doctors called "advanced liver disease."

The Austrian doctors cautioned people who read their report to bear in mind the following:

  • As their patients had advanced liver disease, they were already at high risk for liver cancer (and its recurrence in people who previously had this cancer).
  • Since they were already at high risk for liver cancer, the development of such tumours in relation to the timing of DAA therapy could have occurred by "chance."
  • Although regular ultrasound scans, and in some cases CT or MRI scans, are recommended as part of liver cancer screening, they note: "Even the best imaging methods cannot exclude a small [liver tumour with 100% certainty]."
Advertisement

The doctors concluded that an apparently increased risk for liver cancer in some patients who have been treated with DAAs might be due to the following factor:

  • older age -- this represents a surrogate or stand-in indicating prolonged chronic HCV infection. Long-term HCV infection would have allowed more time for scarring of the liver to have occurred and therefore an increased risk for liver cancer.

The Austrian doctors also found it "difficult to develop" a highly robust estimate of the risk for liver cancer in their clinic's population. However, their interim data suggest that among patients who were cured of HCV with DAAs the subsequent risk for developing liver cancer is about 5%.

They also stated that among 94 other patients in their clinic who were cured of HCV with a combination of interferon and ribavirin, 10 developed liver cancer after nearly eight years of monitoring. Thus, about 11% of these 94 interferon-treated patients developed liver cancer. This is another piece of evidence underscoring that interferon-based therapy does not provide 100% protection from the risk of developing liver cancer.

The Austrian doctors stated that their findings have several implications, including the following:

  • Patients with cirrhosis should undergo regular screening for liver cancer even after they have been cured of HCV.
  • Treating HCV-infected patients who do not have cirrhosis as early as possible may help to reduce their future risk for developing liver cancer.


References

  1. Kozbial K, Moser S, Schwarzer R, et al. Unexpected high incidence of hepatocellular carcinoma in cirrhotic patients with SVR following IFN-free DAA treatment. Journal of Hepatology. 2016; in press.
  2. Cammà C, Cabibbo G, Craxì A. Direct acting antiviral agents and risk for HCC early recurrence: much ado about nothing. Journal of Hepatology. 2016; in press.
  3. Reig M, Mariño Z, Perelló C, et al. Unexpected early tumor recurrence in patients with hepatitis C virus -related hepatocellular carcinoma undergoing interferon-free therapy: a note of caution. Journal of Hepatology. 2016; in press.
  4. Reig M, Torres F, Mariño Z, et al. Reply to Camma et al and Torres et al. Journal of Hepatology. 2016; in press.
  5. Pol S. Lack of evidence of an effect of direct acting antivirals on the recurrence of hepatocellular carcinoma: The ANRS collaborative study group on hepatocellular carcinoma (ANRS CO22 HEPATHER, CO12 CIRVIR and CO23 CUPILT cohorts). Journal of Hepatology. 2016; in press.
  6. Bruix J, Sherman M; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology. 2011 Mar;53(3):1020-2.
  7. Meniconi RL, Komatsu S, Perdigao F, et al. Recurrent hepatocellular carcinoma: a Western strategy that emphasizes the impact of pathologic profile of the first resection. Surgery. 2015 Mar;157(3):454-62.
  8. Kim DJ, Clark PJ, Heimbach J, et al. Recurrence of hepatocellular carcinoma: importance of mRECIST response to chemoembolization and tumor size. American Journal of Transplantation. 2014 Jun;14(6):1383-90.


Related Stories

Caution Needed About Claims of Increased Risk of Liver Cancer Recurrence With Use of DAAs
Barcelona: Reports of Unexpected Cases of Liver Cancer in People Undergoing Treatment With DAAs
Large Review From Three French Studies Finds No Link Between Use of DAAs and Recurrence of Liver Cancer



This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication TreatmentUpdate. Visit CATIE's Web site to find out more about their activities, publications and services.

No comments have been made.
 

Add Your Comment:
(Please note: Your name and comment will be public, and may even show up in
Internet search results. Be careful when providing personal information! Before
adding your comment, please read TheBody.com's Comment Policy.)

Your Name:


Your Location:

(ex: San Francisco, CA)

Your Comment:

Characters remaining:

Advertisement

The content on this page is free of advertiser influence and was produced by our editorial team. See our content and advertising policies.