Antiviral therapy cuts progression to cancer in hepatitis

By Sally Robertson, B.Sc.Oct 25 2012

Antiviral therapy may prevent the most common form of liver cancer developing among patients who have hepatitis C-related fibrosis or cirrhosis, report researchers.

Furthermore, the therapy seemed to be effective irrespective of a patient's virologic response.

Antiviral therapy for patients with hepatitis C may lead to a sustained loss of the virus or an initial response that is followed by relapse within a few months of treatment.

However, whether a sustained virologic response (SVR) is the key factor leading to a reduced risk for developing hepatocellular carcinoma (HCC) is not known, explain Dahl Kimer (Copenhagen University Hospital, Denmark) and colleagues.

The team's systematic review and meta-analyses of eight randomized controlled trials and five prospective cohort studies shows that 81 (7%) of 1156 patients who took antiviral therapies (interferon or pegylated interferon alone or with ribavirin) developed HCC compared with 129 (1%) of 1074 who took placebo or no therapy.

A random effects meta-analysis showed that antiviral therapy reduced the HCC risk by almost half, at a relative risk (RR) of 0.53.

The size of the effect was clinically relevant, with a number needed to treat of eight patients after a median of 5 years, reports the team.

Further analysis showed that patients with an SVR had an 85% reduction in risk for HCC, while among nonresponders the risk was reduced by 43%.

"Although the intervention was more beneficial among sustained virological responders than nonresponders, there was a clear effect in both patient groups," writes the team in BMJ Open.

Chronic inflammation of the liver is critical to the development of HCC and hepatitis C patients who have cirrhosis or fibrosis are more likely to have a greater degree of inflammation than patients who do not.

"It is therefore likely that patients without fibrosis or cirrhosis have a smaller benefit of antiviral therapy than the patient population included in our analysis," notes the team.

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