Liver cancer may still develop after successful DAA therapy, especially in patients with cirrhosis

Since the introduction of direct-acting antiviral (DAA) therapy, treatment for hepatitis C (HCV) was revolutionized, as patient outcomes are improved with fewer side effects and high cure rate. However, there is significant debate in the society based on studies that suggest HCV cure does not eliminate risk for hepatocellular carcinoma (HCC) or liver cancer. Other research suggests the possibility of increased risk of developing liver cancer during and after DAA treatment in patients with hepatitis C.

Cirrhosis – a risk factor for liver cancer

A recent study presented at The Liver Meeting held by the American Association for the Study of Liver Diseases found patients with hepatitis C who take DAA medication are at an increased risk for more aggressive, infiltrative patterns of cancer, should they develop it.

Dr. Alberti, professor of gastroenterology at University of Padova in Italy, and his team recently looked at the incidence of new cases of liver cancer among HCV patients with advanced liver disease (such as cirrhosis) who were treated with DAAs. In different analyses of the data, Dr. Alberti’s team found elevated liver enzymes and low platelet count to be associated with liver cancer risk. The best baseline predictor of liver cancer risk was APRI scores, which calculate scarring or fibrosis in the liver. The researchers find the risk of developing liver cancer increased linearly by 10 per cent at each one-point increase in APRI value. This meant that cirrhotic patients with more severe fibrosis are at higher risk of liver cancer.

Risk of liver cancer remains even after DAA

“The results of this study indicate that there is no pharmacological prevention of HCC even with successful antiviral therapy, at least during the first six to 12 months after initiation of treatment,” Dr. Alberti stated.

Another study conducted by Dr. Thomas Baumert at the University of Strasbourg, France investigated the mechanism behind the development of HCC following HCV cure. They found that HCV infections produce changes in the liver that were only partially reversed by DAAs and that they persist after HCV cure. Both studies suggest liver cancer may still develop even after successful DAA treatment, as DAAs only remove the hepatitis C virus, while protection from liver cancer is not guaranteed.

Post-treatment monitoring of cirrhosis and care

In view of the above, it is essential that patients treated with DAAs with advanced liver disease like cirrhosis should continue to be monitored for HCC. Dr. Alberti’s team also recommended that those with compensated cirrhosis who have undergone successful DAA treatment should be monitored for liver cancer after 50 years of age. 

Apart from monitoring, post-treatment care for the liver is also necessary. As mentioned previously, DAAs only remove the hepatitis virus, but not the damage that has been done. Therefore, to prevent advancement of liver disease and liver cancer, we must first enhance the liver’s recovery ability and reverse fibrosis so that normal liver function is resumed.