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Direct-acting antivirals for hepatitis C not linked to higher liver cancer risk in most studies
Liz Highleyman, 2017-04-21 07:40:00

People with hepatitis C who take treatment with direct-acting antivirals (DAAs) do not appear to have a higher risk of developing liver cancer compared to those treated with interferon, and the seemingly higher rates seen in some studies are attributable to risk factors such as older age and more advanced liver disease, according to a set of studies presented Thursday at the International Liver Congress in Amsterdam. The Congress is the annual meeting of the European Association for the Study of the Liver (EASL).

Over years or decades, chronic hepatitis C virus (HCV) infection can lead to serious liver disease including cirrhosis and hepatocellular carcinoma (HCC). Successful treatment of hepatitis C ­– sustained virological response, or continued undetectable HCV RNA at 12 week post-treatment – is expected to reduce the risk of liver disease progression and development of HCC. But liver damage is not fully reversible, and people who already have cirrhosis when they start therapy remain at ongoing risk for liver cancer.

To date there has been conflicting evidence about the likelihood of liver cancer occurring or recurring after treatment with DAAs versus interferon-based therapy.

At last year's EASL meeting, researchers reported the first data suggesting that people who achieve sustained response with DAAs might be at greater risk for liver cancer. Italian researchers reported that hepatitis C patients with cirrhosis who were treated with DAAs had a higher likelihood of developing liver cancer, but this was limited to recurrence in people with a prior history of HCC. A Spanish study published in the October 2016 edition of Journal of Hepatology also saw a higher than expected rate of HCC recurrence.

In contrast, a study presented at the American Association for the Study of Liver Diseases (AASLD) Liver Meeting in November found that treatment with DAAs was not linked to higher HCC risk in a Northern Italian cohort, although there was some evidence that people treated with the new drugs may experience more aggressive disease progression.