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Nucleos(t)ide therapy for HBV does not increase risk for all cancers

BARCELONA — New data presented at the International Liver Congress showed patients with chronic hepatitis B virus infection who receive long-term treatment with nucleos(t)ide analogues did not have an increased risk for all cancers. However, a slight increase in the development of colorectal and cervical cancers was observed, suggesting routine screening for these types of cancers among these patients is necessary.

Grace Wong, MD, professor in the department of medicine and therapeutics at The Chinese University of Hong Kong, and colleagues evaluated the data of 44,494 patients with chronic HBV found in the Hospital Authority database between 2000 and 2012. Of these patients, 4,782 were treated with nucleos(t)ide analogues and 39,712 were not. The primary outcome was the incidence of malignancies other than hepatocellular carcinoma.

During a median follow-up of 4.7 years, malignancies including HCC were found in 2.1% of all untreated patients (n = 835) and 1.3% excluding HCC (n = 528) compared with 5.7% of all treated patients including HCC (n = 274) and 2.7% of patients excluding HCC (n = 128).

The most common cancers observed — besides HCC — were lung and pleural, colorectal, breast, cervical and urinary/renal. In patients treated with nucleos(t)ide analogues, 28 developed lung and pleural cancers, 15 developed colorectal, four developed breast, two developed cervical and six developed urinary/renal cancers, compared with 117, 41, 43, 33 and 31 patients in the untreated group, respectively.

“Our large-scaled population-based study does not suggest an increased risk of all cancers in patients with chronic hepatitis B receiving long-term oral nucleos(t)ide analogues,” Wong told healio.com/Hepatology.

The patients in the nucleos(t)ide analogues-treated group had the same risks for developing all malignancies when compared with untreated patients after propensity score weighting. However, these patients had a trend to have higher risks for the development of colorectal cancer (weighted HR = 2.17; 95% CI, 1.08-4.36) and cervical cancer (weighted HR = 4.41; 95% CI, 1.01-19.34). These higher risks were no longer significant after Bonferroni correction of multiple comparisons (P > .0038), according to the research.

“In subgroup analysis, there seemed to be increased risks of colorectal cancer, and possibly cervical cancers in female patients receiving long-term oral nucleos(t)ide analogues. However, as the absolute numbers of these two cancers were small (five and two, respectively) in the treated subgroup, this observation requires independent confirmation,” Wong said.

Wong and colleagues recommend screening for colorectal and cervical cancers in these patients according to international recommendations.

In a press release from EASL, Tom Hemming-Karlsen, MD, PhD, EASL vice-secretary, said, “This large-scale study determines an important link between nucleos(t)ide analogue treatment and cervical and colorectal cancer. The results are important and could change cancer surveillance and management of patients treated for hepatitis B.” – by Melinda Stevens

Reference:

Wong H-L G, et al. Abstract PS052. Presented at: International Liver Congress; April 13-17, 2016; Barcelona.

Disclosure: Wong reports consulting for Gilead Sciences and hosting lectures sponsored by AbbVie, Bristol-Myers Squibb, Echosens, Furui, Gilead Sciences and Janssen. Please see the abstract for a list of all other researchers’ disclosures.