Hep C 'cure' doesn't eliminate liver cancer recurrence

Last Updated: 2018-08-13

By Anne Harding

NEW YORK (Reuters Health) - Patients remain at risk of recurrent hepatocellular carcinoma (HCC) after treatment with oral direct-acting antivirals (DAA), according to a new systematic review and meta-analysis.

"Even after patients have achieved virologic cure with these agents, we need to monitor them for recurrence of hepatocellular carcinoma," Dr. Sonal Singh, an associate professor of medicine at the University of Massachusetts School of Medicine in Worcester and the study's first author, told Reuters Health by phone.

A 12- or 24-week regimen of oral DAAs clears hepatitis C and results in sustained viral response (SVR) for most patients, but the effect of treatment on long-term outcomes has not been adequately investigated, Dr. Singh and his team write in Frontline Gastroenterology, online July 30. Studies of whether DAA reduces HCC risk have had mixed results, they add.

To look at the "real world" effect of oral DAAs on the incidence and recurrence of HCC, the researchers reviewed eight controlled studies and 36 uncontrolled studies.

Pooled HCC incidence was 1.5% in the uncontrolled studies and 3.3% in the controlled studies, while HCC recurrence was 16.7% and 20.1%, respectively.

About one in 67 patients on oral DAAs will develop incident HCC, while one in six will develop recurrent HCC, Dr. Singh and his colleagues estimate.

"The overall quality of the evidence was low for each of the outcomes and comparisons. In the absence of high-quality controlled cohorts with long-term follow-up, our findings can neither confirm nor rule out an increase or decrease in the risk of incident or recurrent HCC after oral DAA therapy," Dr. Singh and his team write.

Patients who achieve SVR with DAA treatment are considered to be cured of hepatitis C, Dr. Singh said. "Cure means suppression of the virus, but the complications of the disease such as hepatocellular carcinoma may not necessarily have been taken care of, and that's why we need follow-up."

Future studies should look at the effect of SVR on other long-term clinical outcomes including hepatic encephalopathy, liver failure, gastrointestinal bleeding, portal hypertension, hepatorenal syndrome and long-term mortality, he and his colleagues note.

SOURCE: https://bit.ly/2vHngtb

Frontline Gastroenterol 2018.