How to manage increased cancer risks from DAA hepatitis C treatment?

DAAs (direct-acting antivirals) are the latest hepatitis C treatment option introduced to the market, their high price tag has caused great controversy since their introduction but recently people are worried about something else – DAA’s possible side effects. Recent findings revealed that DAAs could lead to aggressive growth of hepatocellular carcinoma (HCC) or liver cancer.

In a Spanish study, investigators noted a "high rate of cancer recurrence" after patients with a history of hepatocellular carcinoma were treated with direct-acting antivirals. The study revealed a 28% rate of radiologic tumor recurrence in their study sample.

Follow-up data from the Barcelona Clinic Liver Cancer Group also found that at a median of 12 months, the rate of recurrence for liver cancer was 31% in 77 patients with hepatitis C and a history of hepatocellular carcinoma who were treated with DAAs. [1]

This aggressive growth of liver cancer was discovered by Dr Brillanti’s team. “A 30% rate over 3 years from initial surgery or ablation is normal. What was surprising to us was that we were observing 4 cm lesions after 12 weeks.”, lead investigator Stefano Brillanti, MD, from the University of Bologna, Italy, stated. [2]

 This was also supported by an Israeli study that showed the same pattern, “When we observed the efficacy of direct-acting antivirals, we started to see some cases of malignancies,” said study investigator Assaf Issachar, MD, from the Rabin Medical Center in Petah Tikva, Israel. He continued, “it is concerning; you can't ignore it,”. [3]

At the moment, the cause of this cancer risk is still unknown, and it will take time for researchers and scientists to understand more on this matter. Meanwhile, facing the possible risks of post treatment liver cancer, is there anything patients can do to prevent it?

For those who are considering the use of DAAs, the first thing you should ask is – Is eliminating HCV really necessary? Or is it possible to control the damage and recover liver function without eliminating HCV? 

There are actually many cases where people who are infected with HCV can live with the virus for life without having liver problems. This suggests that being infected with HCV does not necessary equals having liver injury. People who have HCV can consider improving and recovering liver function without using DAAs.

As for those who have successfully eliminated HCV and achieved SVR, it is essential to have regular check-ups to monitor liver condition. It is also important to use external liver protection to enhance the liver’s function to prevent abnormal liver cell growth.

Research data has shown that even with HCV in the body, it is possible to control liver function and prevent liver injury; it has also been proven that elevated ALT level due to chronic hepatitis C is reversible. In addition, preventing abnormal cell growth and HCC is also possible with the right kind of liver support. [4] [5] [6]