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Friday, November 18, 2016
AASLD, 2016: Focus on Liver Cancer and DAAs
This year at The Liver Meeting® — held by the American Association for the Study of Liver Diseases (AASLD 2016) — there were a lot of presentations on Liver Cancer (HCC) and the new DAAs. Over the past decade, the prevalence of cirrhosis has increased by almost 40 percent among people with hepatitis C (HCV) in the United States. The proportion of hepatitis C patients with cirrhosis and its complications has grown significantly in the past decade, particularly among those over 60, and as the studies below show, older people and those with cirrhosis are at higher risk than others of developing HCC. US: Large Study Identifies Increase of Cirrhosis in Hepatitis C Patients
A study from British Columbia found that the risk of liver cancer was reduced by 80% in people cured of hepatitis C compared to those who were not cured. This particular study did not look at the relationship between exposure to DAAs and liver cancer risk (others did—see below). The take away message was that although curing hepatitis C infection greatly reduces the risk of developing liver cancer, it does not eliminate the risk entirely. Older people and those with cirrhosis are at higher risk than others, underlining the importance of early diagnosis and treatment. The impact of sustained virological response to HCV infection on long term risk of hepatocellular carcinoma: the BC Hepatitis Testers Cohort
More directly, another study found that patients with hepatitis C who take direct-acting antiviral medication are at no higher risk for developing liver cancer than those who do not take the medication. However, they might be at an increased for more aggressive, infiltrative patterns of cancer, should they develop it. They concluded that the risk of developing HCC is not increased by oral DAAs, being closely dependent on stage of disease. Is There an Increased Risk of Cancer After Taking Direct-Acting Antiviral Medication?
Another study evaluated the effectiveness of direct antiviral agents for hepatitis C virus patients with hepatocellular carcinoma (HCC). The study aimed to understand the real-world effectiveness of sofosbuvir (SOF), ledipasvir/sofosbuvir (LDV/ SOF) and paritaprevir/ritonavir/ombitasvir and dasabuvir (PrOD) by hepatitis C genotype and clinically relevant subgroup. SVR rates were very high (similar to those patients without cancer) but did not cure the cancer. AASLD 2016: Efficacy of Antiviral Agents for Hepatitis C in HCC Patients
Last, another study tried to determine if it was more cost-effective to treat patients with liver cancer pre-transplant or post-transplant. The study found that it was cost-effective to treat pre-transplant. Treating before transplant also decreased liver-related mortality and increased sustained virologic response. Pre-treatment did not have any impact at time of the liver transplant waitlist. AASLD 2016: Cost-Benefit of Treating Hepatitis C in HCC Patients Before Transplant
So, the take away message is: More and more people have cirrhosis and are at risk of liver failure and liver cancer, but DAAs work. DAA’s won’t cause liver cancer and can be used successfully in patients who have liver cancer and decompensated cirrhosis. While treating HCV in patients with liver cancer (HCC) doesn’t cure the cancer it can cure the HCV. As there is no magic bullet for treating liver cancer, the take away message seems to be that treatment with DAAs should be done before a liver transplant. Hopefully, a successful liver transplant in a person cured of HCV who has HCC will work. Only problem: Where are the livers? Is anyone telling us something we don’t already know, or is it just me! CD
Other News:
AbbVie’s Investigational, Pan-Genotypic Regimen of Glecaprevir/Pibrentasvir (G/P) Shows High SVR Rates in Chronic Hepatitis C Patients with Severe Chronic Kidney Disease
98 percent of patients across all major HCV genotypes (GT1-6) with severe chronic kidney disease (CKD), including patients on dialysis, achieved SVR12 with 12 weeks of G/P in the primary intent-to-treat analysis, regardless of previous treatment status or presence of compensated cirrhosis – 100 percent of patients achieved SVR12 in a modified intent-to-treat analysis – G/P is an investigational, pan-genotypic, once-daily, ribavirin-free, fixed-dose combination for the treatment of chronic HCV.
Merck Announces Findings for Investigational Triple-Combination Chronic Hepatitis C Therapy Showing High Rates of Sustained Virologic Response in People with Genotypes 1, 2 or 3 Infection
Phase 2 data presentations at The Liver Meeting ® detail SVR12 rates from two studies as well as SVR8 rates in patients for whom direct-acting antiviral treatment previously failed. The strong findings observed following treatment with MK-3682B are an encouraging step towards Merck’s goal of developing and delivering a shorter-duration, pan-genotypic next-generation treatment regimen for more patients with chronic hepatitis C infection.
Rise in known Hepatitis C cases possibly due to improved screening
Hepatitis C might be on the rise locally, according to a new report from the Chatham-Kent Public Health Unit. Part of the problem comes from a reluctance to seek help based on the slow progression of the disease. As Hepatitis C and poverty are often correlated it is safe to assume many people with the disease struggle in other aspects of their life, especially related to permanent housing. Seeking treatment is therefore not a priority.
Liver Damage from Supplements Is on the Rise
Green-tea extract and bodybuilding pills pose a particular risk, study finds. You’ve probably heard that too much alcohol or excessive amounts of certain medications can damage your liver, an organ that helps your body extract the nutrients it needs from food and eliminate toxic substances from your blood. But a new review suggests that many herbal remedies and dietary supplements can also harm the liver, including some that you can easily buy online.