- The American Gastroenterological Association (AGA) has released a practice update that includes recommendations for timing of HCV direct-acting antiviral (DAA) therapy in patients with hepatocellular carcinoma (HCC).
Why this matters
- The clinical practice update presents available evidence regarding DAAs and HCC incidence/recurrence.
- Treatment with DAAs is associated with a reduction in HCC risk, regardless of the presence of cirrhosis.
- Patients with advanced liver fibrosis or cirrhosis should undergo HCC surveillance before initiating DAA and should remain in surveillance.
- Surveillance should include ultrasound, with or without Alpha-fetoprotein (AFP) every 6 months.
- Patients with HCC:
- Those eligible for curative resection or ablation should defer DAA until after treatment.
- Those eligible for liver transplantation should time DAA therapy based on wait times, availability of HCV-positive organs, and liver dysfunction.
- In active, immediate, or advanced HCC, benefit and cost-effectiveness of DAA are unclear.
- In patients with complete response to HCC therapy, it is unclear how DAA affects recurrence risk. DAAs should not be withheld, but can be delayed 4-6 months. Surveillance should continue indefinitely with dynamic contrast-enhanced CT or MRI every 3-6 months.