Patients with hepatitis C virus (HCV) taking direct-acting antiviral (DAA) treatments, who have been treated for hepatocellular carcinoma (HCC), had a high rate of cancer recurrence, according to a new study presented at the annual International Liver Congress in Barcelona, Spain (abstract LBP506).
The researchers found that 29% of patients with a history of HCC redeveloped the condition during or after taking DAAs.
“Even in a relatively short observation period, we have shown that a high recurrence rate of hepatocellular carcinoma can occur in hepatitis C patients taking direct-acting antivirals,” said Federica Buonfiglioli, MD, DIMEC, of the University of Bologna, Italy, and one of the researchers who participated in the study.
Although more research is needed, Dr. Buonfiglioli added: “We believe our findings justify close monitoring for all cirrhotic patients on such treatments.”
In the Italian study, the researchers analyzed the medical records of 344 HIV-negative patients with HCV-related cirrhosis who did not have active HCC. Most patients were men, with a median age of 63 years (range, 29-85 years of age). Most patients (69%) had genotype 1 HCV, and 55% had experienced a treatment failure on peginterferon and ribavirin. All patients had received treatment with one of the following DAA combinations: sofosbuvir (Gilead) and simeprevir (Janssen; 34%); ABT-450 with ritonavir (AbbVie), ombitasvir (AbbVie), dasabuvir and ribavirin (three-DAA combination; 22%); sofosbuvir-ribavirin (17%); sofosbuvir and daclatasvir (Bristol-Myers Squibb; 16%); and ledipasvir-sofosbuvir (Gilead) (10%).
They assessed HCV occurrences by comparing baseline-enhanced ultrasonography and MRI/CT scans with those taken during the six-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 HCC was detected in 7.6% of all patients (n=26) without a history of HCC—deemed to be a “standard rate” by the study authors. However, in the 59 patients who had a history of HCC, a “high rate” of 29% (n=17) led to recurrence of the condition. A single nodule was found in 21 patients and multiple nodules in five.
The researchers recommended that patients with cirrhosis, who are treated with DAAs, be closely monitored for cancer after treatment.
“These initial findings provide important insight to how hepatitis C management strategies could be developed to detect HCC early in patients who are most at risk,” said Laurent Castera, MD, PhD, the secretary general of the European Association for the Study of the Liver. “These findings deserve further investigation given their clinical significance.”
According to the World Health Organization, liver cancer accounts for 662,000 deaths and is the third leading cause of cancer-related death, exceeded only by cancer of the lung and stomach. Approximately 75% to 80% of cases of HCC occur in Asia; however, there is considerable variation within continents. The overwhelming majority of HCC cases occurs in patients with chronic liver disease, of whom approximately 80% to 90% have cirrhosis, and most of the remainder have moderate to advanced fibrosis.
Source-Clinical Oncology News