ILC 2016: High Rate of Cancer Recurrence Found in Patients With Hepatitis C Taking Direct-Acting Antiviral Treatments
Data from a new study show that patients with hepatitis C virus (HCV) taking direct-acting antiviral treatments who have previously been diagnosed with hepatocellular carcinoma had a high rate of redeveloping their illness. The large retrospective cohort study (Abstract LBP506), presented by Buonfiglioli et al on April 13, 2016 at The International Liver Congress in Barcelona, Spain, found 29% of patients who had a history of hepatocellular carcinoma redeveloped the condition during or after taking direct-acting antivirals.
The overwhelming majority of hepatocellular carcinoma cases occur in patients with chronic liver disease, where approximately 80% to 90% have cirrhosis, and most of the remainder have moderate to advanced fibrosis.
“Even in a relatively short observation period, we have shown that high recurrence rates of hepatocellular carcinoma can occur in hepatitis C patients taking direct-acting antivirals,” said Federica Buonfiglioli, MD, of the University of Bologna, Italy. “Even though further investigation is needed, we believe our findings justify close monitoring for all cirrhotic patients on such treatments.”
Study Findings
In the Italian study, medical records of 344 HIV-negative patients with HCV-related cirrhosis who did not have active hepatocellular carcinoma were analyzed. All patients had received treatment with one of the following direct-acting antiviral combinations: sofosbuvir and simeprevir (34%); 3D combination (ABT-450 with ritonavir [ABT-450/r], the NS5A inhibitor ombitasvir, and the nonnucleoside polymerase inhibitor dasabuvir and ribavirin) (22%); sofosbuvir and ribavirin (17%); sofosbuvir and daclatasvir (16%); and sofosbuvir and ledipasvir (10%). Occurrences of hepatocellular carcinoma were assessed by comparing baseline enhanced-ultrasonography and magnetic resonance imaging (MRI)/computed tomography (CT) scans with those taken during the 6-month post-treatment follow-up.
Sustained virologic response was achieved in 89% of patients at 12 weeks post-treatment. At 24 weeks post-treatment, active hepatocellular carcinoma was detected in 7.6% of all patients (n=26) without a history of hepatocellular carcinoma—deemed to be a “standard rate” by the study authors. However, in the 59 patients who had a previous history of hepatocellular carcinoma, a rate of 29% (n=17) redeveloped the condition.
“These initial findings provide important insight to how hepatitis C management strategies could be developed to detect hepatocellular carcinoma early in patients who are most at risk,” said Laurent Castera, MD, PhD, European Association for the Study of the Liver (EASL) Secretary General. “These findings deserve further investigation given their clinical significance.”
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