Fewer liver cancers in HBV patients on long-term entecavir

Last Updated: 2016-07-06

By Will Boggs MD

NEW YORK (Reuters Health) - Patients with chronic hepatitis B virus (HBV) infection who are receiving long-term treatment with entecavir had lower than expected hepatocellular carcinoma (HCC) rates in a recent retrospective study.

The risk of HCC in chronic hepatitis B patients ranges from <1% per year in those without cirrhosis to 2-3% per year in those with cirrhosis. The Risk Estimation for Hepatocellular Carcinoma in Chronic Hepatitis B (REACH-B) model accurately estimates the predicted risk of HCC in these patients.

To evaluate the effect of entecavir on HBV-related HCC, Dr. Joseph Ahn from Oregon Health and Science University in Portland and colleagues studied 646 patients who took entecavir for at least 12 months in the ENUMERATE study. They compared the expected incidence of HCC based on the REACH-B model to the observed incidence in this cohort.

Among cirrhosis-free patients, REACH-B predicted 4.7 cases by the end of the first year, but only 3 patients actually develop HCC, a 36% reduction of the expected risk.

With longer observation, entecavir treatment was associated with up to a 64% reduction in the expected incidence of HCC.

In patients with cirrhosis, however, observed HCC rates did not differ significantly from expected rates, the authors reported June 21st online in The American Journal of Gastroenterology.

After excluding HCC cases diagnosed in the first year, observed HCC rates were significantly lower than expected for the entire cohort (71% lower) and for patients without cirrhosis (90% lower), while observed and expected HCC rates remained similar in cirrhotics.

"Entecavir antiviral therapy was associated with a lower than expected incidence of HCC," the researchers conclude. "However, the risk of HCC persisted in patients with chronic hepatitis B and careful surveillance for HCC remains warranted in these patients regardless of the response to entecavir antiviral treatment."

Dr. Ahn did not respond to a request for comments.

SOURCE: http://go.nature.com/29qEbGi

Am J Gastroenterol 2016.