8 reports on liver cancer outcomes with HCV, DAA therapy

Patients with hepatitis C have an increased risk for disease progression to cirrhosis and potentially hepatocellular carcinoma. Recent studies have focused on defining liver cancer risks related to HCV progression and the rates of liver cancer after HCV clearance with new direct-acting antivirals.

The folloing include several recent that refute previous data suggesting that DAA therapy may increase the risk for liver cancer. Rather, researchers have found it more likely that any increased risk for HCC after DAA therapy is linked to baseline risk factors. Additional include data on liver cancer incidence among patients with comorbidities.

DAAs for HCV do not increase liver cancer recurrence after local-regional therapy

Recently published data showed no association between direct-acting antiviral therapy and an increased risk for hepatocellular carcinoma recurrence among liver transplantation candidates with hepatitis C who experienced initial complete response to local-regional therapy.

“The majority of recent publications reveal no increased risk of liver cancer in patients treated with DAAs — both in terms of de novo HCC and recurrence after complete response to HCC treatment,” Norah Terrault, MD, from the University of California, San Francisco, told HCV Next. “These studies highlight the limitations of earlier studies that were uncontrolled and thus unable to account for differences in the patients in the current DAA era (older, more advanced cirrhosis) and prior pegylated-interferon era.” Read more

Novel score predicts DAA benefit in patients with HCV, decompensated cirrhosis

Researchers have developed a predictive score that quantifies the potential benefits of direct-acting antiviral therapy for patients with hepatitis C and decompensated cirrhosis, according to recently published data.

Five factors – BMI, hepatic encephalopathy, ascites, serum albumin and alanine aminotransferase levels – contribute to the novel BE3A score. Read more

DAA therapy improves HCV-related liver transplantation outcomes

The high efficacy of direct-acting antivirals correlated with significant improvement in survival of patients who underwent liver transplantation for hepatitis C-related liver disease, according to a recently published study.

“Hepatitis C virus (HCV) infection is the main cause of end-stage liver disease leading to liver transplantation (LT) in the Western world, and until the widespread use of the direct-acting antiviral regimens (DAA) it had a significant detrimental impact on posttransplant patient and graft survival,” Gonzalo Crespo, MD, from the Hospital Clínic de Barcelona, Spain, and colleagues wrote. “Considering the tremendous impact of HCV recurrence in the results of LT, it is clear that DAA will dramatically change the scenario of liver transplantation, probably contributing also to long-term improvements in survival.” Read more

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HCV liver cancer resection outcomes similar in patients with diabetes

Results of a comparative study of patients with and without diabetes who underwent curative liver resection for hepatitis C-related hepatocellular carcinoma showed that diabetes did not affect surgical outcomes and was not an unfavorable factor in selecting candidates.

“It is still controversial whether [diabetes] influences the survival of patients with HCC after resection. Such discrepancies in the results in each investigation could be attributed to the diversity of patient backgrounds, as well as the number of patients,” Naoki Yoshida, MD, from the Nihon University School of Medicine, Japan, and colleagues wrote. “In the present study, [diabetes] did not appear to have a negative impact on patients’ survival after HCC resection, suggesting that [diabetes] is not an exclusion criterion for HCC surgery under good glycemic control.” Read more

Liver cancer incidence after HCV therapy linked to risk factors, not treatment

Direct-acting antiviral treatment for hepatitis C did not correlate with an increased risk for hepatocellular carcinoma in a large cohort study of both treated and untreated patients with or without cirrhosis. Those with incident HCC after DAA treatment had higher risk factors at baseline.

“There was no increased risk for HCC as a result of having received DAA therapy whatsoever,” Raymond T. Chung, MD, director of Hepatology and Liver Center at Massachusetts General Hospital, told Healio Gastroenterology and Liver Disease. “The risk was related to their preexisting likelihood of developing HCC. The fact that HCC developed post-DAA, we think, is more likely to be an accident of timing than the idea that it's related to receipt of DAA — these persons were at risk for HCC whether they received DAAs or not.” Read more

HCC rates after interferon-free HCV treatment linked to baseline risk factors

Recently published data suggest that higher hepatocellular carcinoma incidence after sustained virologic response with interferon-free hepatitis C treatment correlates to patient baseline risk factors, such as age, Child-Turcotte Pugh score and prior treatment, rather than IFN-free therapy.

“Recent studies from Europe have warned that the risk of HCC occurrence in cirrhotic individuals may be higher after attaining an IFN-free hepatitis C cure versus an IFN-containing cure,” Hamish Innes, MD, from the Glasgow Caledonian University, and colleagues wrote. “Although this finding could have major implications for the treatment of HCV, the studies on which it was predicated did not carry out multivariate adjustment for confounding factors, and involved small sample sizes only.” Read more

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HCV clearance lowers liver cancer risk by 70% no matter drug of choice

Reaching sustained virologic response with direct-acting antivirals reduced the occurrence of hepatocellular carcinoma by 71%, but all treatments that cleared the virus saw a similar reduction in risk, according to a presenter at The Liver Meeting 2017.

“Our results show that DAA-induced SVR is associated with a 71% reduction in HCC,” George N. Ioannou, MD, from the Veterans Affairs Puget Sound Healthcare System and the University of Washington, said in his presentation. “Eradication of HCV is associated with a similar reduction in HCC irrespective of the regimen that is used to achieve that eradication.” Read more

Fewer HCC cases from HCV clearance improves quality of life, cost savings

Through treatment of hepatitis C genotype 1 with direct-acting antivirals, significant direct and indirect cost savings may arise due to fewer cases of hepatocellular carcinoma and decompensated cirrhosis, according to results of a simulated model presented at The Liver Meeting 2017.

“As you know, chronic hepatitis C is a systemic infection that’s associated with adverse clinical outcomes, both hepatic as well as extrahepatic,” Zobair M. Younossi, MD, MPH, chairman of the department of medicine at Inova Fairfax Hospital and vice president for research at Inova Health System in Falls Church, Virginia, said in his presentation. “There is a significant burden associated hepatic infection and there’s also a number of, as studies have shown, that hepatitis C impairs patient-reported outcome such as health-related quality of life. Read more