HCV: APASL issues guidelines for HCC monitoring in the DAA era

  • Kanda T & al.
  • Hepatol Int
  • 20 Sep 2019

  • International Clinical Digest
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Takeaway

  • The Asian Pacific Association for the Study of the Liver (APASL) has issued new guidelines for hepatocellular carcinoma (HCC) occurrence and recurrence evaluation among patients who achieve sustained virological response (SVR) with HCV direct-acting antivirals (DAAs).

Supporting data

  • Across 6 studies (N=602), the post-SVR HCC recurrence rate was 29.6% during a mean 15.4-month period post-DAA initiation.
  • Across 10 studies (N=45,870), the rate of de novo HCC after SVR was 1.3% during a mean of 18.2 months post-DAA initiation, similar to that observed in the interferon era.

Recommendations for patients with DAA-achieved SVR

  • Prior HCC: evaluate with ultrasound and tumor markers at 4-month intervals.
  • No prior HCC or advanced fibrosis/cirrhosis: evaluate for HCC at 6-month intervals by ultrasound±tumor markers before, during, and for ~2 years posttherapy, and at 1-year intervals thereafter until long-term DAA effects are ascertained, particularly with respect to resolution of liver fibrosis.
    • Tumor markers are recommended in the presence of advanced liver fibrosis/cirrhosis.
  • Regular HCC surveillance is indicated in patients with diabetes and/or alcohol abuse.
  • Patients with advanced fibrosis/cirrhosis should be endoscopically screened for esophageal and gastric varices.
  • The above provides only an overview, and clinicians should consult the complete guidelines for details.
  • Funding: None.

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