Monday, March 5, 2018

Minireview - DAAs and the occurrence or recurrence of HCC among patients with HCV related liver disease

World J Hepatol. Feb 27, 2018; 10(2): 267-276
Published online Feb 27, 2018.
doi: 10.4254/wjh.v10.i2.267

Impact of direct acting antivirals on occurrence and recurrence of hepatocellular carcinoma: Biologically plausible or an epiphenomenon?
Amna Subhan Butt, Fatima Sharif, Shahab Abid

The ground breaking discovery of the new group of direct acting antiviral agents (DAAs) had led to a paradigm shift in the management of chronic hepatitis C (CHC) which is the most common cause of hepatocellular carcinoma (HCC) in Japan, Pakistan, United States and many European countries[1,2]. With annual incidence of HCC ranging from 1% to 7% in patients with HCV related cirrhosis, (HCC) is a leading cause of morbidity and the second most common cause of cancer related deaths worldwide[3,4]. Besides contribution of several host and viral factors in the pathogenesis of disease progression, achieving sustained virologic response (SVR) has been found as the single most important factor in reducing HCV associated HCC incidence[5].

The novel DAAs not only provided a potent, oral alternative to injectable interferons, but also had a shorter duration of treatment, better efficacy with over 90% achievement of SVR and a more favorable side effect profile[6]. However, since 2016, concerns were raised regarding the effect of DAAs on progression to HCC[7]. In addition, their long-term benefits including impact on HCC have been questioned in the context of specific populations and subgroups which were not included in the landmark trials investigating DAA based therapy[3].

Therefore, this review aims to explore existing molecular studies as well as clinical observations in order to determine whether there is an association between the use of DAAs and the occurrence or recurrence of HCC among patients with HCV related liver disease. We also aim to evaluate whether there is a subset of the population in which this phenomenon has been observed.

Full text review:
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Of Interest
Clinical Care Options
How I Manage HCC Risk Following HCV Cure
Paul Y. Kwo MD - 2/14/2018
Which patients, who have achieved a sustained virologic response with HCV treatment, need to be screened for hepatocellular carcinoma? Here’s my approach.

This page offers an index of links to current data investigating the possible risk of developing liver cancer (hepatocellular carcinoma, or HCC) during and after direct-acting antiviral therapy in patients with hepatitis C.

Liver cancer incidence after HCV therapy linked to risk factors, not treatment
Li DK, et al. Hepatol. 2017;doi:10.1002/hep.29707.
Direct-acting antiviral treatment for hepatitis C did not correlate with an increased risk for hepatocellular carcinoma in a large cohort study of both treated and untreated patients with or without cirrhosis. Those with incident HCC after DAA treatment had higher risk factors at baseline. “There was no increased risk for HCC as a result of having received DAA therapy whatsoever,” Raymond T. Chung, PhD, director of Hepatology and Liver Center at Massachusetts General Hospital, told Healio Gastroenterology and Liver Disease. 

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