Gregory Dore at the International Liver Congress 2017. Photo by Liz Highleyman, hivandhepatitis.com
People with hepatitis C who take treatment with
direct-acting antivirals (DAAs) do not appear to have a higher risk of
developing liver cancer compared to those treated with interferon, and the
seemingly higher rates seen in some studies may be attributable to risk factors
such as older age and more advanced liver disease, according to a set of
studies presented
last week at the International Liver Congress in Amsterdam.
At
last year's EASL meeting, researchers reported
the first data suggesting that people who achieve sustained response with
DAAs might be at greater risk for liver cancer. Italian researchers reported
that hepatitis C patients with cirrhosis who were treated with DAAs had a
higher likelihood of developing liver cancer, but this was limited to
recurrence in people with a prior history of hepatocellular carcinoma (HCC),
the most common type of liver cancer. A Spanish study published
in the October 2016 edition of Journal of Hepatology
also saw a higher than expected rate of HCC recurrence.
In
contrast, a study presented at the American Association for the Study of
Liver Diseases (AASLD) Liver Meeting in November found that treatment with DAAs
was
not linked to higher HCC risk in a Northern Italian
cohort. However, there was some evidence that, if people treated with the new
drugs do develop HCC, they may experience more aggressive tumour progression.
Gregory
Dore of the Kirby Institute at the University of New South Wales presented
results from a systematic review and meta-analysis of more than 40 studies of
initial or recurring HCC following DAA treatment.
People
who had taken DAA treatment who initially developed liver cancer were older, on
average, than those treated with interferon (60 vs 52 years). The age
difference was less pronounced for people with recurrent HCC (64 vs 66 years,
respectively).
People
treated with DAAs also had more advanced liver disease.
Taking
these differences into account, the meta-analysis found no significant
difference in the risk of developing liver cancer between people treated with
DAAs and people treated with interferon-based regimens.
New
studies from France, China, Japan and Scotland presented at the meeting
similarly found no increased risk of liver cancer.
However,
Spanish researchers reported a higher rate of recurrence of liver cancer in
people who had undergone DAA treatment.
Taken
together, these study findings underscore the need for ongoing liver cancer
monitoring for people who had cirrhosis before starting hepatitis C treatment and
for people with a prior history of HCC – even after they are cured of hepatitis
C – and support early DAA treatment before people develop advanced liver
disease.
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