Thursday, June 28, 2018

HCV clearance by direct antiviral therapy and occurrence/recurrence of hepatocellular carcinoma: still an issue?

HCV clearance by direct antiviral therapy and occurrence/recurrence of hepatocellular carcinoma: still an issue? 
Francesco Paolo Russo, Martina Tessari, Angela Imondi, Erica Nicola Lynch, Fabio Farinati

Hepatoma Res 2018;4:25. | | © The Author(s) 2018
Received: 4 May 2018 | First Decision: 15 May 2018 | Revised: 10 Jun 2018 | Accepted: 16 Jun 2018 | Published: 27 Jun 2018 

In conclusion, the risk reduction in hepatic decompensation as well as in HCC incidence in patients achieving SVR is the only proven evidence. The reports about the increased risk of HCC occurrence/recurrence in DAA treated patients are afflicted by selection and methodologic biases, that weaken the impact of these studies. We strongly believe that is mandatory to treat HCV-infected patients with DAAs but also to maintain an active surveillance for liver cancer as the guidelines suggest; the previously presented data must be considered with caution.

New regimens with direct-acting antivirals (DAAs) agents have changed both efficacy and safety of hepatitis C virus (HCV)-treatment, as almost all patients can be treated and cured at any stage of liver disease. The rates of sustained virological response to currently available combinations exceed 95% in real-life practice. However, conflicting results have been produced on the occurrence/recurrence of hepatocellular carcinoma (HCC) in patients with HCV-associated cirrhosis treated with DAAs. In this review we analyse the data available in the literature in order to elucidate the impact of DAAs on the risk of HCC occurrence in patients without previous history of tumor, and of recurrence after successful treatment of the tumor. Data on “de novo” HCC incidence were quite homogeneous, suggesting that the treatment with DAAs does not modify the risk of HCC developing during the first 6-12 months after HCV eradication. On the contrary, HCC recurrence rates after DAAs were extremely variable across different studies, reflecting a large heterogeneity in this clinical setting. The possibility that treatment with DAAs may favour tumour growth and spread in individual patients with active HCC foci is supported by some observations but remains unproven. 

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