Hepatocellular Carcinoma Occurrence and Recurrence after Antiviral Treatment in HCV-Related Cirrhosis. Are Outcomes Different after Direct Antiviral Agents? A Review

Abstract

Hepatitis C virus (HCV) infection is one of the major causes of hepatocellular carcinoma (HCC) worldwide. In the last decades, several studies have showed a lower rate of HCC occurrence or recurrence in patients with HCV-related cirrhosis after interferon-based antiviral therapies compared to untreated controls, even without reaching viral clearance. Unfortunately, interferon regimens could only yield viral clearance in approximately half of the patients. The recent development of new all-oral regimens with direct-acting antivirals (DAAs) has radically improved the cure rate to above 90%. In respect to these findings, many would have thought that interferon-free regimens would decrease the development and recurrence of HCC. Literature data have unexpectedly reported high rates of both the occurrence and recurrence of HCC after therapy with DAAs. However, it is probably too early to express some concerns. More recent data showed that both occurrence and recurrence of HCC are decreased by the DAAs. Interferon-free therapy is definitely not without limits. Together with the initial thoughts of an increased risk of HCC, these may lead to an unwanted restricted access to interferon-free regimens in specific subpopulations. This issue should be settled as soon as possible because millions of hepatitis C patients are and will be using DAAs in the present and future. Our purpose is to review the existing literature and to offer a more precise and rational interpretation of the existing data.Key words: – – e – .Abreviations: AFP: alpha-fetoprotein; DAA: direct antiviral agent; HCC: hepatocellular carcinoma; HCV: hepatitis C virus; HR: hazard ratio; IFN: interferon; LDV: Ledispavir; SMV: Simeprevir; SOF: Sofosbuvir; SVR: sustained virologic response.

Hepatic resection for two giant hepatocellular carcinoma after oral direct-acting antiviral therapy: Is there a relationship?

“…Other reports regarding this issue could not find clear relationship. Spârchez et al [23] in a review article regarding this issue concluded that the current available literature is unclear and the risk of HCC needs to be better clarified with prospective randomized controlled trials. Kanwal et al [24] found that the overall annual incidence of HCC was markedly higher in patients who did not achieve SVR with direct-acting antiviral drugs compared to those who did.…”

Hepatite C

“…Houve dessa forma, uma otimização farmacocinética que possibilitou concentrações séricas mais elevadas e mais duradouras que agiam com pressão constante sobre o vírus. Além disso, possibilitou a administração de apenas uma injeção semanalmente [34][35][36] .…”

Treatment of hepatitis C virus infection in patients with hepatocellular carcinoma: Truth or dare?

“…After almost one decade of experience, there is now clear data that DAA therapy lowers HCC occurrence 3,11 . Moreover, after the initial alarming reports of a higher recurrence rate in patients with previous HCC treatment, 12 we now have prospective studies providing evidence that the risk of early HCC recurrence after DAA therapy is similar to or lower than what was observed in interferon‐treated or untreated controls, thus settling the initial concerns 13,14 .…”