Clinical and Virological Responses to Clevudine Therapy of Hepatocelluar Carcinoma Patients with Chronic Hepatitis B

Abstract

Background/Aims: The clinical effects of clevudine have been reported in patients with chronic hepatitis B virus infections (CHIs). In this investigation, we assessed whether clevudine induced biochemical and virological improvements in hepatocellular carcinoma (HCC) patients with CHI. Methods: Fifty-four patients who received 30 mg clevudine for more than 24 weeks between 2007 and 2009 at the National Cancer Center Hospital, Korea, were enrolled. Among these cases, 39 had HCC (CHI/HCC group) and 15 did not (CHI group). Results: In relation to the CHI group, the CHI/HCC group was older (55.5 years.) and had a higher liver cirrhosis rate (79.5%) (p<0.05). Median changes in serum hepatitis B virus (HBV) DNA levels from baseline at weeks 12, 24, and 36 of treatment in the CHI/HCC group were not signifi cantly different from those of the CHI group (-2.3, -2.7, -2.6 vs -1.7, -1.8, -2.4, respectively). HBV DNA <2,000 copies/mL was achieved in 76.5% of the CHI/HCC group at 24 weeks. Rates of ALT normalization in the CHI/HCC and CHI groups were 62.5% and 66.7%, respectively (p>0.05). Liver function was preserved with clevudine treatment in patients displaying response or stable disease under anti-cancer therapy. Four patients (7.4%) developed viral resistance during clevudine therapy. Among these, one was naïve, and three had previously received antiviral therapy. One CHI/HCC patient (1.9%) discontinued clevudine treatment due to symptomatic myopathy. Conclusions: Our findings clearly indicate that clevudine has comparable antiviral and biochemical effects in patients with CHI and with CHI/HCC and preserves the underlying liver function in HBV-related HCC patients. (Gut Liver 2011;5:82-87) HBV re-activation and chronic hepatitis B exacerbation. In addition, high HBV load prior to chemotherapy has an adverse effect on the survival of HCC patients with chronic HBV infection (CHI). 8 These findings suggest that incorporation of antiviral therapies to reduce the HBV viral load should be considered in the management of HBV-related HCC. Antiviral treatment may render HBV-related HCC patients more tolerant of HCC therapy, ultimately leading to better prognosis. A previous study by our group showed for the first time that lamivudine has comparable antiviral effects in patients with CHI and CHI/HCC and improves underlying liver function in the latter group. MATERIALS AND METHODS PatientsThis study is a retrospective evaluation of 54 CHI patients receiving 30 mg clevudine (Levovir ; Buckwang Pharmaceutical Co., Seoul, Korea) once a day for at least 6 months from August 2007 to February 2009 at the National Cancer Center Hospital (Goyang, Korea). Among the patients, 39 had chronic hepatitis B infection and HCC (CHI/HCC group), and 15 had CHI without HCC (CHI group). Patients with other viral infections, including hepatitis C, D, and human immunodeficiency virus, were excluded. All patients from both groups contained serum HBV DNA >10 5 copies/mL, as assessed using the branched DNA method. Moreover, all patients displayed ser...

Antiviral efficacy of lamivudine versus entecavir in patients with hepatitis B virus‐related advanced hepatocellular carcinoma

“…reported similar viral and biochemical effects of LAM in CHB patients with and without HCC. Woo et al 38 . reported that clevudine had comparable antiviral and biochemical effects in CHB patients with and without HCC.…”