Unexpected early tumor recurrence in patients with hepatitis C virus -related hepatocellular carcinoma undergoing interferon-free therapy
Reig M (1), Mariño Z (2), Perelló C (3), Iñarrairaegui M (4), Ribeiro A (1), Lens S (2), Díaz A (5), Vilana R (6), Darnell A (6), Varela M (7), Sangro B (4), Calleja JL (3), Forns X (2), Bruix J (8).
(1) Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
(2) Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona. CIBERehd, Barcelona, Spain.
(3) Liver Unit. Hospital Universitario Puerta de Hierro. CIBERehd. IDIPHIM, Madrid, Spain.
(4) Unidad de Hepatología, Clínica Universidad de Navarra, IDISNA, CIBERehd, Pamplona, Spain.
(5) Department of Pathology, BCLC group, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Spain.
(6) Department of Radiology, BCLC group, Hospital Clinic Barcelona, University of Barcelona, Spain.
(7) Liver Unit. Hospital Universitario Central de Asturias, Oviedo.
(8) Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
BACKGROUND AND AIMS:
The success of direct acting antivirals against hepatitis C is a major breakthrough in Hepatology. Until now, however, there are very few data on the effect of HCV eradication in patients who have already developed hepatocellular carcinoma.
The study included patients with HCV infection and prior history of treated hepatocelullar carcinoma who achieved complete response and lacked 'non-characterized nodules' at the time they underwent anti-HCV treatment with all-oral direct acting antivirals in 4 hospitals.
Patients receiving interferon as part of the antiviral regimen were excluded. The baseline characteristics, laboratory and radiologic tumor response were registered in all patients before starting antiviral therapy and during the follow-up according to the clinical practice policy.
Between 2014 and 2015, 103 patients with prior hepatocellular carcinoma received DAA, 58 of them met the inclusion criteria. After a median follow-up of 5.7 months, 3 patients died and 16 developed radiologic tumor recurrence (27.6%).
The pattern of recurrence was: intrahepatic growth (3 patients), new intrahepatic lesion (1 nodule in 5 patients, up to 3 nodules less or equal to 3 cm in 4 cases and multifocal in one patient) and infiltrative ill-defined hepatocellular carcinoma and/or extra-hepatic lesions in 3 patients.
Our data show an unexpected high rate and pattern of tumor recurrence coinciding with HCV clearance and, though based in a very small cohort of patients, should be taken as a note of caution and prime a large scale assessment that exceeds the individual investigators capacity.
High rate of cancer recureence after DAA treatment in patients with prior hepatocellular carcinoma. Disruption of immune surveillance may facilitate the emergence of metastatic clones.
CITATION J Hepatol. 2016 Apr 12. pii: S0168-8278(16)30113-1. doi: 10.1016/j.jhep.2016.04.008