Previous studies have shown that antiviral treatment reduces the incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. But in a small study by researchers from the Division of Gastroenterology and Hepatology at Thomas Jefferson University, antiviral therapy was also shown to prevent recurrence of HCC and extend survival.
The standard of care for HCC is local ablation of the tumor, unless it is large or has metastasized. HCC tumors, however, often recur, or new lesions develop.
In the study in the International Journal of Cancer, a team led by Hie-Won Hann, MD, Professor of Medicine at Jefferson Medical College, reported that the median survival in patients who received antiviral therapy after HCC diagnosis was 60 months vs only 12.5 months in those who did not.
“The virus drives the cancer, and by suppressing the virus and making it undetectable we can extend the survival for these patients,” Dr. Hann said in a news release.
The study included 15 patients with chronic hepatitis B who received local ablation of a single HCC tumor that was less than four cm. The first six patients were diagnosed between 1991 and 1997, prior to the development of antiviral therapy. These patients were considered historical controls.
The other nine, diagnosed between 2000 and 2004, began ongoing antiviral therapy with lamivudine immediately after HCC diagnosis. Other antiviral medications, such as tenofovir and adefovir were added to the regimen if resistance to lamivudine developed, or even without drug resistance.
All patients who received the antiviral therapy maintained undetectable hepatitis B virus in serum and continued the therapy. Seven of the nine patients have not developed a new HCC or recurrence. The longest survivors are the two patients who came with HCC in 2000. They are doing well, free of cancer for more than 10 years. All patients continue with the antiviral therapy and are followed at three to four month intervals.
“The other option for these patients is liver transplantation, which carries its own risks,” said another of the authors, Robert Coben, MD. “This is an attractive alternative for this patient population.”
© 2010 Lippincott Williams & Wilkins, Inc.