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Nearly one-third of patients with previous HCC recur after DAA therapy
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BARCELONA — Though hepatocellular carcinoma after direct-acting antiviral therapy rarely occurs, patients with a history of HCC recurred at a rate of 29%, according to a presenter at the International Liver Congress.
“A history of previous HCC was the strongest predictor of the development of a new HCC after DAA therapy. The more advanced liver disease and younger age were risk factors for HCC recurrence in the subgroup of patients with previous HCC,” Stefano Brillanti, MD, assistant professor of medicine, University of Bologna, Italy, said during a press conference at the International Liver Congress 2016.
Stefano Brillanti
This large, retrospective cohort study included consecutive patients (n = 344) without HIV who had hepatitis C-related cirrhosis of Child Pugh A or B. Patients received various DAA combinations, none of which impacted sustained virologic response or HCC occurrence. Researchers followed them for 24 weeks after therapy concluded.
At that time, HCC occurred in 7.6% of patients overall (n = 26), but in the 59 patients with a history of HCC, the rate was 29% (n = 17). Of those without a history, HCC occurred in just 3.2% (n = 9; P = .0001).
There were three other predictive factors for development of HCC after DAA therapy. Baseline Child Pugh B was present in just 10.1% of those who did not develop HCC, but in 26.9% of those who did develop HCC (P = .02). Liver stiffness was greater than 21.3 Kpa in a greater percentage of HCC cases (P = .005). And platelets were lower in those who developed HCC (P = .02).
Among those with a previous history of HCC, younger age (56 vs. 73 years) and treatment experience (88.2% vs. 61.9%) were indicators of HCC recurrence.
“Cirrhotic patients should be closely monitored after treatment and the biologic significance of our findings needs to be better defined,” Brillanti said. – by Katrina Altersitz
Reference:
Buonfiglioli F. Abstract LBP506. Presented at: International Liver Congress; April 13-17, 2016; Barcelona.
Disclosure: Brillanti reports grant support from Gilead Sciences and being a consultant for Janssen.
Perspective
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Laurent Castera, MD, PhD
You have to be very cautious. The facts are that we currently have two independent studies from two different countries showing similar results that these high rate, early recurrence of HCC in patients treated with DAA with previous HCC. This is unexpected. We suspect that it is a disruption of immune surveillance because this has not been seen with the previous treatment. Of course, we need more data, longer follow-up before we achieve any firm conclusion. This should heighten awareness and we should be cautious when treating these patients.
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