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Reuters Health Information: Direct-acting antivirals cut risk of liver cancer

Direct-acting antivirals cut risk of liver cancer

Last Updated: 2017-10-23

By Megan Brooks

NEW YORK (Reuters Health) - Eradicating hepatitis C virus (HCV) with direct-acting antiviral (DAA) therapy reduces the risk of hepatocellular carcinoma by 71%, according to results of a large observational study.

Most primary liver cancers in the United States occur in patients with HCV infection, and it is "tempting to assume that if we eradicate hepatitis C, the risk of liver cancer will also be eradicated or at least substantially reduced," lead investigator Dr. George N. Ioannou from University of Washington School of Medicine in Seattle, said in a news release.

"However, patients with hepatitis C may already have developed cirrhosis or advanced fibrosis before the hepatitis C is eradicated, which may put them at risk of liver cancer even after hepatitis C is eradicated. Furthermore, recent studies suggested an increased risk of liver cancer in patients with HCV who were treated with the new DAAs. This made it all the more imperative for us to determine whether DAA-induced eradication of HCV is associated with a reduction in liver cancer risk using an adequately powered study," said Dr. Ioannou.

He presented his research during a press briefing October 21 at The Liver Meeting, held by the American Association for the Study of Liver Diseases.

The findings are based on 62,051 patients who underwent 83,695 antiviral treatment regimens in the VA Puget Sound Healthcare System. The data included 35,873 interferon-only regimens, 26,178 DAA regimens with or without interferon, and 21,644 DAA-only regimens.

The researchers identified 3,271 new cases of liver cancer diagnosed at least 180 days after the start of antiviral treatment during an average follow-up of 6.1 years.

The incidence of liver cancer was highest in patients with cirrhosis who failed treatment (3.25 per 100 patient-years) - followed by patients with cirrhosis and sustained virological response, or SVR, (1.97); no cirrhosis and treatment failure (0.87); and no cirrhosis and SVR (0.24).

In multivariable models adjusted for potentially confounding factors, SVR was associated with a significantly reduced risk of liver cancer, regardless of whether the antiviral treatment was DAA-only (adjusted hazard ratio, 0.29), DAA with interferon (aHR, 0.48) or interferon-only (aHR, 0.32).

"The risk of liver cancer was reduced in both cirrhotic and non-cirrhotic patients," Dr. Ioannou told Reuters Health in a phone interview.

He also noted that a study reported at a European liver meeting last year suggested that patients treated with DAAs for HCV seemed to have a high rate of recurrence of hepatocellular carcinoma.

"That was a very controversial finding because DAAs eradicate hepatitis C with minimal side effects, and everything we know about hepatitis C and hepatocellular carcinoma tells us that if you eradicate hepatitis C, you should expect to reduce the risk of liver cancer not increase it," Dr. Ioannou noted.

"After that report, I think a lot of people were somewhat more cautious about antiviral treatment. So it was very important to clarify that. And in some ways, our study deals with a more important and bigger issue - which is not recurrence, but do DAAs prevent the development of liver cancer in the first place?" Dr. Ioannou said.

"Our results, I think, are very definitive as far observational studies go, in that we did show that the eradication of hepatitis C with DAAs was associated with a 71% reduction in hepatocellular cancer risk," Dr. Ioannou told Reuters Health.

"Eradicating hepatitis C will have a tremendous benefit in reducing liver cancer in individuals and in the entire population," he added in the news release. "Physicians and patients should not be withholding antiviral treatment for fear of inducing liver cancer. On the contrary, physicians should be treating hepatitis C specifically to reduce the risk of liver cancer."

The study is currently in press in the journal Hepatology.

The study had no commercial funding. Dr. Ioannou has received grant/research support from Janssen Pharmaceuticals.


The Liver Meeting 2017.

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