Spurred by reports from other cities, doctors in Bologna, Italy, have reviewed their database to assess possible risk factors for liver cancer development and recurrence in 344 participants who were treated for hepatitis C virus (HCV) infection with direct-acting antivirals (DAAs) in 2015. All participants had extensive scarring of the liver (cirrhosis) prior to DAA treatment and were therefore at heightened risk for developing liver cancer.
As a result of treatment with DAAs, 91% of participants were cured. Readers should note that despite participants being cured cirrhosis does not immediately resolve. Such severe scarring of the liver takes years to develop and it will take years for the liver to repair and regenerate. During the time when the liver is repairing itself, because there is still scarred tissue, liver cancer can still arise.
After successful treatment with DAAs, participants were monitored for 24 weeks. Subsequently, technicians detected liver cancer in 26 out of 344 participants (8%). The cases of liver cancer were distributed as follows:
- 17 out of 59 participants (29%) with a history of liver cancer
- nine out of 285 participants (3%) without a history of liver cancer
Liver Cancer Recurrence in Context
The Bologna doctors stated that in their experience liver cancer recurrence after treatment for liver cancer is "not uncommon." Indeed they found it useful to put the present reports of liver cancer in context. They did this by referring to a major study that monitored participants who were treated for liver cancer (and who did not receive modern-day DAAs). One year after liver cancer treatment, 20% of participants had a recurrence of this disease. The Bologna researchers stated, "Therefore, our finding of a [29%] recurrence rate in patients ... was not unexpected."
The researchers concluded by stating that in patients with HCV-related cirrhosis, cure with DAAs "does not seem to reduce the occurrence of liver cancer in the short-term."
In light of their findings, the Bologna doctors recommend that all patients with cirrhosis undergo the following:
- close monitoring during and after DAA therapy
- regular screening for liver cancer even if they are cured of HCV
As liver cancer risk is influenced by the presence of cirrhosis, the Bologna doctors recommend: "When possible, [DAA] treatment should be started early, before the development of cirrhosis."
Conti F, Buonfiglioli F, Scuteri A, et al. Early occurrence and recurrence of hepatocellular carcinoma in HCV-related cirrhosis treated with direct acting antivirals. Journal of Hepatology. 2016; in press.