HCV cirrhosis: DAAs have no effect on early HCC recurrence

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Takeaway

  • HCV therapy with direct-acting antivirals (DAAs) does not accelerate or prevent early recurrence of hepatocellular carcinoma (HCC).
  • Waiting ≥12 months between HCC treatment and antiviral therapy may be advisable.

Why this matters

  • The potential risk for DAA-induced HCC recurrence remains controversial.
  • Patient factors and DAA timing may be contributing factors, irrespective of DAA response.

Study design

  • French case-control study of 71 patients with HCV-related compensated cirrhosis and complete response to HCC treatment.
  • DAA-treated patients (n=22) were matched 1:2 with 49 non-treated patients based on age, sex, liver function, cancer stage, and treatment.
  • Median time to DAA initiation, 12 months.
  • Funding: None.

Key results

  • Most initial HCC was Barcelona Clinic Liver Cancer stage A (DAA-treated, 95%; non-treated, 94%).
  • HCV-1 was the most common genotype (82%, 86%).
  • Rate of sustained virologic response was 86%.
  • DAA-treated and non-treated patients had similar HCC recurrence rate (41% vs 35%; P=.7904), time to progression (12 months vs 14 months; P=.7688), and clinical characteristics on progression.
  • Median time interval between HCC treatment and DAA therapy was significantly shorter among patients with vs without HCC recurrence (7.0 months vs no recurrence, 36.0 months; P=.0235).
  • No DAA-treated patients died from liver failure (vs non-treated, 30%).

Limitations

  • Small, retrospective, monocentric study.