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ASCO 2015: Variations in Liver Cancer Attributable to Hepatitis Virus Variations

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Key Points

  • Patients with hepatitis B virus (HBV) were more likely to develop hepatocellular carcinoma at a younger age than those with hepatitis C virus (HCV) and presented with more aggressive disease.
  • Patients with HCV-associated cancer were more likely to exhibit underlying cirrhosis, a history of greater alcohol and cigarette use, and a higher rate of diabetes.
  • Recent studies have reported a rise in hepatocellular carcinoma in the United States and Western Europe, largely due to an increase in HCV-related liver disease, which accounts for roughly half of all U.S. cases.

Significant clinical variations exist among patients with the most common type of liver cancer, hepatocellular carcinoma, depending on the viral cause of the disease—hepatitis B virus (HBV) or hepatitis C virus (HCV). These differences suggest that hepatitis status should be considered when developing treatment plans for newly diagnosed patients, according to researchers at The University of Texas MD Anderson Cancer Center. These findings were presented at the ASCO 2015 Annual Meeting (Abstract 4011).

Building off Previous Research

This research builds on previous studies of differential effects of demographics, geographical distribution, and risk factors—including hepatitis status—on treatment outcomes among patients with inoperable hepatocellular carcinoma. In these earlier studies, researchers observed different outcomes based on demographics and geographic patients distribution (Asia vs Europe and the United States) among patients receiving the same local or systemic therapy approaches. They hypothesized that these differences might be attributed to variations with regard to hepatitis type, among other factors.

“Currently, a patient's form of hepatitis is not a factor in treatment planning, but the two types of the virus result in different disease impacts and some variations in outcomes. Most likely, this is related to the difference in how hepatitis leads to cancer development, in addition to the differences in the natural history of both hepatitis forms. This might be the result of treating technically different diseases the same way,” said principal investigator Ahmed Kaseb, MD, Associate Professor of Gastrointestinal Medical Oncology at MD Anderson. “This study provides more evidence that future clinical trials should stratify patients by hepatitis type to help identify better drugs and create personalized treatment modalities.” 

Study Findings

In the current study, researchers investigated detailed characteristics of 815 hepatocellular carcinoma patients treated at MD Anderson between 1992 and 2011, assessing a range of disease-state variables and survival rates. HBV is a DNA virus and HCV is an RNA virus, and it has previously been unclear whether this difference might influence the clinical-pathologic features of hepatocellular carcinoma or patient outcomes.

Researchers found that patients with HBV were more likely to develop hepatocellular carcinoma at a younger age than HCV patients and presented more aggressive disease, marked by advanced diagnosis stage (3–6), high alpha-fetoprotein, poorly differentiated tumor cells, larger tumor size, extent of cancer in the liver (> 50% of the liver volume), and portal thrombosis. Patients with HCV-associated cancer were more likely to exhibit underlying cirrhosis, a history of greater alcohol and cigarette use, and a higher rate of diabetes.

One-year survival rates were similar between the two groups (43.3%), and the median survival rates were 10.9 and 9.3 months for patients with HCV and HBV, respectively. 

According to an editorial authored by Dr. Kaseb published in Oncology, roughly 700,000 patients are newly diagnosed with hepatocellular carcinoma each year, and more than two-thirds of new cases are from the Asia-Pacific region and mainly linked to chronic HBV infection. Recent studies have reported a rise in the number of cases in the United States and Western Europe, largely due to an increase in HCV-related liver disease, which accounts for roughly half of all U.S. cases. However, most patients are not candidates for any curative treatments because of advanced disease at diagnosis and/or a background of advanced chronic liver disease.

“Eligibility for certain treatments depends on cancer staging at diagnosis. Thus, this study has major implications for determining how we treat new hepatocellular carcinoma patients,” said Dr. Kaseb. “Especially for patients with HBV, we need to determine if more aggressive treatment is warranted at the outset.”

This work was supported by the National Institutes of Health. For full disclosures of the study authors, view the study abstract at abstract.asco.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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