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Honma Y, Shibata M, Morino K, Koya Y, Hayashi T, Ogino N, Kusanaga M, Oe S, Miyagawa K, Abe S, Tabaru A, Harada M. Impact of Interferon-Free Direct-Acting Antivirals on the Incidence of Extrahepatic Malignancies in Patients with Chronic Hepatitis C. Dig Dis Sci 2023; 68:685-698. [PMID: 36100828 DOI: 10.1007/s10620-022-07686-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The incidence of extrahepatic malignancies (EHMs) after hepatitis C virus (HCV) eradication by interferon (IFN)-based and IFN-free direct-acting antivirals (DAAs) treatment remains unclear. AIMS The aim was to evaluate the cumulative incidence of EHMs diagnosed for the first time after the antiviral treatments. METHODS We analyzed a total 527 patients with chronic HCV infection and without prior history of any malignancies who achieved sustained virological response by antiviral treatments, including IFN-based (n = 242) or IFN-free DAAs (n = 285). The baseline predictors for EHM occurrence were analyzed using Cox regression analysis. RESULTS Thirty-two patients were diagnosed with EHMs, 14 in IFN-based and 18 in IFN-free DAAs, respectively. The total duration of follow-up was 1,796 person-years in IFN-based and 823 person-years in IFN-free DAAs. The incidence of EHMs in IFN-based and IFN-free DAAs was 7.8 and 21.9 per 1,000 person-years, respectively. The cumulative incidence of EHMs was significantly higher in IFN-free DAAs than IFN-based (p = 0.002). IFN-free DAAs was a single independent predictor for incidence of EHMs (p = 0.012). As for gender, the incidence of EHMs was significantly higher in IFN-free DAAs only in the female cohort (p = 0.002). After propensity score matching, IFN-free DAAs was a single independent predictor for incidence of EHMs in the female patients (p = 0.045). CONCLUSIONS The incidence of EHMs after HCV eradication is higher in IFN-free DAAs than IFN-based regimens, especially in female patients. We should carefully follow-up not only HCC but also EHMs after IFN-free DAAs regimens.
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Affiliation(s)
- Yuichi Honma
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
| | - Michihiko Shibata
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Kahori Morino
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Yudai Koya
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
- Department of Gastroenterology, Moji Medical Center, 3-1 Higashiminato-machi, Moji-ku, Kitakyushu, 801-8502, Japan
| | - Tsuguru Hayashi
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Noriyoshi Ogino
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Masashi Kusanaga
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Shinji Oe
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Koichiro Miyagawa
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Shintaro Abe
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
| | - Akinari Tabaru
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
- Department of Gastroenterology, Wakamatsu Hospital of the University of Occupational and Environmental Health, 1-17-1 Hama-machi, Wakamatsu-ku, Kitakyushu, 800-0024, Japan
| | - Masaru Harada
- Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan
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Sanduzzi-Zamparelli M, Mariño Z, Lens S, Sapena V, Iserte G, Pla A, Granel N, Bartres C, Llarch N, Vilana R, Nuñez I, Darnell A, Belmonte E, García-Criado A, Díaz A, Muñoz-Martinez S, Ayuso C, Bianchi L, Fuster-Anglada C, Rimola J, Forner A, Torres F, Bruix J, Forns X, Reig M. Liver cancer risk after HCV cure in patients with advanced liver disease without non-characterized nodules. J Hepatol 2022; 76:874-882. [PMID: 34856322 DOI: 10.1016/j.jhep.2021.11.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Recognition of non-characterized liver nodules (NCLN) prior to direct-acting antivirals (DAAs) is associated with increased hepatocellular carcinoma (HCC) risk in patients with HCV. The risk of HCC has not been defined in F3/F4 patients in whom NCLN have been ruled-out before starting DAAs and at sustained virological response (SVR). This study aimed to estimate HCC incidence in this population. METHODS We performed a prospective study including HCV-infected patients with F3/F4 fibrosis, without a history of HCC, and who achieved SVR after DAAs. Patients were only included if they had undergone ultrasound imaging that excluded the presence of HCC/NCLN within 30 days after SVR. All patients were evaluated every 6 months until developing primary liver cancer, death or withdrawal of informed consent. HCC incidence was expressed per 100 patient-years (/100PY). Adherence to screening program was calculated every 6 months for the first 48 months. RESULTS A total of 185 patients (63/122, F3/F4) were included. Among those with cirrhosis, 92% were Child-Pugh A and 42.7% had clinically significant portal hypertension (CSPH). Albumin-bilirubin score was 1 in 84.9% and 2 in 15.1% of patients, respectively. The median clinical and radiologic follow-up was 52.4 months and 48 months, respectively. Ten patients developed HCC: HCC incidence was 1.46/100PY (95% CI 0.79-2.71) in the whole cohort, 2.24/100PY (95% CI 1.21-4.17) in F4 only and 3.63/100PY (95% CI 1.95-6.74) in patients with CSPH. No HCC was registered in patients with F3. Median time between SVR and HCC occurrence was 28.1 months; 12 non-primary liver cancers were also identified. CONCLUSIONS Patients with cirrhosis without NCLN at SVR remain at risk of HCC development. The absence of HCC in patients with F3 reinforces their marginal cancer risk, but prospective studies are needed to exclude them from screening programs. LAY SUMMARY Patients with HCV-related cirrhosis, without non-characterized liver nodules at sustained virologic response, remain at risk of hepatocellular carcinoma despite viral cure. However, the cancer risk after successful direct-acting antiviral treatment is marginal in patients with F3 fibrosis without non-characterized liver nodules. If confirmed in larger prospective studies, current screening recommendations may need to be revisited in this group of patients.
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Affiliation(s)
- Marco Sanduzzi-Zamparelli
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Zoe Mariño
- Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain
| | - Sabela Lens
- Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain
| | - Victor Sapena
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Gemma Iserte
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Anna Pla
- Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain
| | - Núria Granel
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Concepció Bartres
- Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain
| | - Neus Llarch
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Ramón Vilana
- BCLC Group. Radiology Department Hospital Clinic of Barcelona, University of Barcelona, Spain
| | - Isabel Nuñez
- Radiology Department, Hospital Clinic of Barcelona, Spain
| | - Anna Darnell
- BCLC Group. Radiology Department Hospital Clinic of Barcelona, University of Barcelona, Spain
| | - Ernest Belmonte
- BCLC Group. Radiology Department Hospital Clinic of Barcelona, University of Barcelona, Spain
| | - Angeles García-Criado
- BCLC Group. Radiology Department Hospital Clinic of Barcelona, University of Barcelona, Spain
| | - Alba Díaz
- BCLC Group. Department of Pathology, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain
| | - Sergio Muñoz-Martinez
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Carmen Ayuso
- BCLC Group. Radiology Department Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain
| | - Luis Bianchi
- BCLC Group. Radiology Department Hospital Clinic of Barcelona, University of Barcelona, Spain
| | - Carla Fuster-Anglada
- BCLC Group. Department of Pathology, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain
| | - Jordi Rimola
- BCLC Group. Radiology Department Hospital Clinic of Barcelona, CIBERehd, University of Barcelona, Spain
| | - Alejandro Forner
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Ferran Torres
- Medical Statistics Core Facility, IDIBAPS, Hospital Clinic of Barcelona, Spain; Biostatistics Unit, Faculty of Medicine, Universitat Autònoma of Barcelona, Barcelona, Spain
| | - Jordi Bruix
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Spain.
| | - Maria Reig
- BCLC Group. Liver Unit, Hospital Clinic of Barcelona, IDIBAPS. CIBERehd, University of Barcelona, Barcelona, Spain.
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Lam JO, Hurley LB, Lai JB, Saxena V, Seo S, Chamberland S, Quesenberry CP, Champsi JH, Ready J, Chiao EY, Marcus JL, Silverberg MJ. Cancer in People with and without Hepatitis C Virus Infection: Comparison of Risk Before and After Introduction of Direct-Acting Antivirals. Cancer Epidemiol Biomarkers Prev 2021; 30:2188-2196. [PMID: 34583968 PMCID: PMC8667334 DOI: 10.1158/1055-9965.epi-21-0742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/11/2021] [Accepted: 09/15/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection is a leading cause of liver cancer. The association of HCV infection with extrahepatic cancers, and the impact of direct-acting antiviral (DAA) treatment on these cancers, is less well known. METHODS We conducted a cohort study in a healthcare delivery system. Using electronic health record data from 2007 to 2017, we determined cancer incidence, overall and by type, in people with HCV infection and by DAA treatment status. All analyses included comparisons with a reference population of people without HCV infection. Covariate-adjusted Poisson models were used to estimate incidence rate ratios. RESULTS 2,451 people with HCV and 173,548 people without HCV were diagnosed with at least one type of cancer. Compared with people without HCV, those with HCV were at higher risk for liver cancer [adjusted incidence rate ratio (aIRR) = 31.4, 95% confidence interval (CI) = 28.9-34.0], hematologic cancer (aIRR = 1.3, 95% CI = 1.1-1.5), lung cancer (aIRR = 1.3, 95% CI = 1.2-1.5), pancreatic cancer (aIRR = 2.0, 95% CI = 1.6-2.5), oral/oropharynx cancer (aIRR = 1.4, 95% CI = 1.1-1.8), and anal cancer (aIRR = 1.6, 95% CI = 1.1-2.4). Compared with people without HCV, the aIRR for liver cancer was 31.9 (95% CI = 27.9-36.4) among DAA-untreated and 21.2 (95% CI = 16.8-26.6) among DAA-treated, and the aIRR for hematologic cancer was 1.5 (95% CI = 1.1-2.0) among DAA-untreated and 0.6 (95% CI = 0.3-1.2) among DAA-treated. CONCLUSIONS People with HCV infection were at increased risk of liver cancer, hematologic cancer, and some other extrahepatic cancers. DAA treatment was associated with reduced risk of liver cancers and hematologic cancers. IMPACT DAA treatment is important for reducing cancer incidence among people with HCV infection.
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Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, California.
| | - Leo B Hurley
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jennifer B Lai
- San Rafael Medical Center, Kaiser Permanente Northern California, San Rafael, California
| | - Varun Saxena
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco, California
- University of California San Francisco, San Francisco, California
| | - Suk Seo
- Antioch Medical Center, Kaiser Permanente Northern California, Antioch, California
- Walnut Creek Medical Center, Kaiser Permanente Northern California, Walnut Creek, California
| | - Scott Chamberland
- Regional Pharmacy, Kaiser Permanente Northern California, Oakland, California
| | | | - Jamila H Champsi
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco, California
| | - Joanna Ready
- Santa Clara Medical Center, Kaiser Permanente Northern California, Santa Clara, California
| | - Elizabeth Y Chiao
- Department of General Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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Extrahepatic Malignancies After Treatment with Direct Antiviral Agents for Chronic HCV Infection. J Gastrointest Cancer 2021; 51:584-590. [PMID: 31407252 DOI: 10.1007/s12029-019-00293-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Direct antiviral agents (DAAs) have become the treatment of choice for chronic hepatitis C virus (HCV). A safety concern was raised about a possible relationship between DDAs and malignancies. We report unexpected development of extrahepatic malignancies after DAA treatment. METHODS Four hundred thirty-one patients were treated with DAAs in our unit between January 2015 and February 2018. The most common regimen used the combination of paritaprevir/ritonavir/ombitasvir with/without dasabuvir (PrOD) (141 patients, 32.7%). The most common genotype was G1b (317 patients, 73.5%). RESULTS Nine patients (2.08%) were diagnosed with malignancies after treatment: three patients developed lymphoma, one laryngeal carcinoma, one pancreatic adenocarcinoma, one cervix carcinoma, one lung carcinoma, one developed recurrent transitional cell carcinoma of the urinary bladder, and one developed recurrent metastatic breast cancer. The incidence of these malignancies in the cohort was 696 to 100,000 for lymphoma and 232 to 100,000 for each one of the other malignancies described, while the incidence in the general population is 20, 8.8, 1.7, 44.7, 142, and 89.7 to 100,000, respectively. Five of these patients were treated with PrOD, two with sofosbuvir and daclatasvir, one with simeprevir and sofosbuvir, and one with ledipasvir and sofosbuvir. The occurrence of the malignancies was 3 months to 4 years after the end of the treatment. Besides, 10 patients (2.3%) developed HCC and one developed recurrent aggressive HCC. CONCLUSIONS This report raises a question about a possible relationship between treatment with DAAs and development of extrahepatic malignancies. Thus, data collection from larger cohorts is critical to determine the relationship possibility.
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Direct Antiviral Treatments for Hepatitis C Virus Have Off-Target Effects of Oncologic Relevance in Hepatocellular Carcinoma. Cancers (Basel) 2020; 12:cancers12092674. [PMID: 32961688 PMCID: PMC7565876 DOI: 10.3390/cancers12092674] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Hepatitis C virus (HCV) eradication by direct-acting antiviral agents (DAAs) reduces de novo hepatocellular carcinoma incidence in cirrhosis; however, contrasting evidence on higher incidence of hepatocellular carcinoma (HCC) was reported in patients previously treated for HCC. Here, we showed that sofosbuvir and daclatasvir can modulate cell proliferation, invasion capability and gene expression in HCC-derived cell lines, suggesting that off-target effects of these drugs might be responsible for both the increase and reduction of cell proliferation and migration capability. Off-target gene modulation, mainly affecting mitochondrial functions, ribosomal genes and histones, was consistent with matched phenotypic changes and might account either for pro-oncogenic or tumor-suppressive functions of DAAs, that seemed to be dictated by the molecular background. Abstract Background and Aims: HCV eradication by direct-acting antiviral agents (DAAs) reduces de novo hepatocellular carcinoma (HCC) incidence in cirrhosis; however, contrasting evidence about beneficial or detrimental effects still exists in patients who have already developed HCC. Methods: we investigated whether sofosbuvir and daclatasvir modulate cell proliferation, invasion capability and gene expression (RNA-seq) in HCC-derived cell lines, hypothesizing possible off-target effects of these drugs. Results observed in HCC cell lines were validated in non-HCC cancer-derived cell lines and a preliminary series of human HCC tissues by qPCR and IHC. Results: DAAs can affect HCC cell proliferation and migration capability by either increasing or reducing them, showing transcriptomic changes consistent with some unexpected drug-associated effects. Off-target gene modulation, mainly affecting ribosomal genes, mitochondrial functions and histones, points to epigenetics and proliferation as relevant events, consistent with matched phenotypic changes. A preliminary validation of in vitro findings was performed in a restricted cohort of HCC patients previously treated with DAAs, with immunohistochemical correlations suggesting DAA-treated HCCs to be more aggressive in terms of migration and epidermal-to-mesenchymal transition. Conclusions: Our findings suggested the possible occurrence of off-target effects ultimately modulating cell proliferation and/or migration and potentially justified previous findings showing some instances of particularly aggressive HCC recurrence as well as reduced incidence of recurrence of HCC following treatment with DAAs.
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Vakiti A, Cho MH, Lee W, Liang JJ, Lalos AT, Fishbein DA. Use of direct-acting antivirals for hepatitis C viral infection and association with intrahepatic cholangiocarcinoma: Is there a linkage? J Oncol Pharm Pract 2018; 25:1743-1748. [PMID: 30253731 DOI: 10.1177/1078155218800147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hepatitis C viral infection is recognized worldwide as a leading cause of cirrhosis and hepatocellular carcinoma. The goal of hepatitis C viral antiviral therapy is the permanent eradication of hepatitis C viral RNA, commonly referred to as a sustained virologic response - defined as "undetectable" RNA at 12 weeks following the completion of therapy. Hepatitis C viral treatment has dramatically advanced with the FDA approval of several new agents known as direct-acting antivirals. These drugs target specific nonstructural proteins of the virus, which disrupt viral replication, and therefore halt infection. However, recently, there has been a concern for increased risk of recurrence of treated hepatocellular carcinoma or denovo occurrence of hepatocellular carcinoma after treatment with direct-acting antivirals. We are now reporting three cases of intrahepatic cholangiocarcinoma that developed after sustained virologic response following hepatitis C viral treatment with direct-acting antivirals.
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Affiliation(s)
- Anusha Vakiti
- 1 Department of Internal Medicine, MedStar Washington Hospital Center, Washington D.C., USA
| | - Min Ho Cho
- 1 Department of Internal Medicine, MedStar Washington Hospital Center, Washington D.C., USA
| | - Wen Lee
- 2 Department of Pathology, MedStar Washington Hospital Center, Washington D.C., USA
| | - John J Liang
- 2 Department of Pathology, MedStar Washington Hospital Center, Washington D.C., USA
| | - Alexander T Lalos
- 3 MedStar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington D.C., USA
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