Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea; Liver Cirrhosis Clinical Research Center, Seoul, Korea; Brain Korea 21 Project for Medical Science, Seoul, Korea, Department of Infectious Disease, Health Sciences University, Ulaanbaatar, Mongolia.
Background/Aims: Little information is available about the antiviral efficacy of lamivudine (LAM) and entecavir (ETV) in patients with hepatitis B virus (HBV)-related advanced hepatocellular carcinoma (HCC). Thus, we compared the antiviral efficacy of LAM and ETV in these patients. Methods: The medical records of 134 antiviral therapy-naïve patients with HBV-related advanced HCC [modified Union for International Cancer Control (UICC) Tumor, Nodes, and Metastases (TNM) stages III-IV] treated between January 2005 and September 2009 were reviewed. After HCC diagnosis, 87 (64.9%) and 47 (35.1%) patients received LAM and ETV, respectively.
Results: The mean age of patients (115 men, 19 women) was 53 years. Sixty-five (48.5%) and 69 (51.5%) patients had TNM stages III and IV HCC, respectively. Treatment outcomes during follow-up, including virologic, biochemical, and serologic responses and appearance of antiviral resistance, were similar in the LAM and ETV groups (all P > 0.05). Multivariate analysis identified Child-Pugh class, alpha-fetoprotein, and TNM stage as independent predictors of overall survival (all P < 0.05). Antiviral agent type (LAM vs. ETV) did not influence overall survival (median 9.6 months in LAM vs. 13.6 months in ETV group; P= 0.493). HCC treatment was not interrupted due to HBV flare up in any patient.
Conclusions: The antiviral efficacy of LAM and ETV was similar and the type of antiviral agent did not influence overall survival in patients with HBV-related advanced HCC. Thus, LAM, which is less expensive than ETV in Korea, might be sufficient to control HBV in these patients.