American Association for the Study of Liver Diseases
53rd Annual Meeting and Postgraduate Course
Boston, MA
November 1-5, 2002
MANY PATIENTS WITH LIVER CANCER FROM HCV CIRRHOSIS HAVE A CURABLE INFECTION
Bennet Downs Cecil, Hepatitis C Treatment Centers INC, Mary Lavelle, Louisville VAMC
Background & Aims: Hepatocellular carcinoma (HCC) occurs in 1-3% of patients with HCV cirrhosis each year. Cure of HCV in cirrhotic patients reduces the incidence of HCC.1 How many patients with HCC have a curable strain of HCV, and could have prevented HCC by earlier treatment?

Methods: We have treated 1400 HCV infected patients (221 with cirrhosis) with antiviral therapy since May 1998. Patients with HCV cirrhosis were screened for HCC using AFP and US. Patients with suspicious masses were referred for open or CT directed biopsy. Antiviral therapy was continued or discontinued based on the desires of the patient, oncologist and surgeon. No patient was offered transplantation.

Results: Eleven patients (7 veterans, 4 private practice) developed HCC while on antiviral therapy. Five were treatment responders (HCV-RNA < 50 IU/ml on treatment) and 1 of 7 became sustained viral responders (HCV-RNA< 50 IU/ml 24 weeks after completion of treatment). The median survival was 1.5 years

Conclusions: Nearly half of our patients with HCC had a curable strain of HCV, with their HCV-RNA falling to less than 50 IU while on antiviral therapy. Two were cured of HCV, being HCV-RNA negative 6 months after completion of treatment. If these patients had started antiviral therapy earlier, they may have avoided liver cancer. Patients with HCV should be offered antiviral therapy to prevent cirrhosis. Aggressive antiviral therapy with cure of HCV in cirrhotic patients is indicated to prevent fatal HCC.

1. Yoshida H, Shiratori Y, Moriyama M, Arakawa Y, Ide T, Sata M, Inoue O, Yano M, Tanaka M, Fujiyama S, Nishiguchi S, Kuroki T, Imazeki F, Yokosuka O, Kinoyama S, Yamada G, Omata M. Interferon therapy reduces the risk for hepatocellular carcinoma: national surveillance program of cirrhotic and noncirrhotic patients with chronic hepatitis C in Japan. IHIT Study Group. Inhibition of Hepatocarcinogenesis by Interferon Therapy. Ann Intern Med 1999 Aug 3;131(3):174-81