Lower HCC Risk Linked to Direct Acting Antivirals

Direct acting antivirals (DAA) significantly reduce the risk of hepatocellular cancer (HCC) among patients with hepatitis C who had a sustained virological response (SVR), according to a recent study.

In the retrospective cohort study, the researchers enrolled 22,500 patients with hepatitis C treated with DAA from 129 Veterans Health Administration hospitals between January 1, 2015 and December 31, 2015. The mean age was 61.6 years and 39% of patients had cirrhosis. Of the patients included in the study, a total of 19,518 patients had attained SVR and 2981 patients had not achieved SVR.
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The researchers calculated annual incidence rates for HCC by SVR. In addition, the risk of HCC was compared among patients with SVR with those without SVR to identify risk factors associated with HCC. Tumor size and stage of cancer at diagnosis was assessed among patients with HCC.

During follow-up, 271 new cases of HCC occurred, 183 of which occurred in patients with SVR.

Overall, patients with SVR had a significantly reduced risk of HCC compared to patients without SVR. Compared to patients without cirrhosis, those with cirrhosis had the highest annual incidence of HCC after SVR, and most cases of HCC were classified as stage I.

“Among patients treated with DAA, SVR was associated with a considerable reduction in the risk of HCC. We did not find any evidence to suggest that DAAs promote HCC,” the researchers concluded. “However, in patients with SVR, the absolute HCC risk remained high in patients with established cirrhosis. These patients should be considered for ongoing HCC surveillance.”

—Melissa Weiss

Reference:

Kanwal F, Kramer J, Asch SM, et al. Risk of hepatocellular cancer in HCV patients treated with direct acting antiviral agents [published online June 19, 2017]. Gastroenterology. http://dx.doi.org/10.1053/j.gastro.2017.06.012.