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Titre : Risk for hepatocellular carcinoma after HCV antiviral therapy with DAAs: case closed?
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Risk for hepatocellular carcinoma after HCV antiviral therapy with DAAs: case closed?

Risk for hepatocellular carcinoma after HCV antiviral therapy with DAAs: case closed?
Raoel Maan, Jordan J. Feld

Gastroenterology
(2017), doi: 10.1053/j.gastro.2017.08.052

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Several studies of patients treated with interferon -based therapy nicely documented that the risk for hepatocellular carcinoma (HCC) was markedly lower in patients who achieved SVR compared to those without SVR. 5-7 As a result, it was naturally assumed that with higher cure rates with DAAs, cancer rates would start to decline. It was therefore surprising and unsettling in 2016 to see a series of reports of unexpectedly high rates of ‘early’ HCC recurrence after ‘curative’ therapy as well as higher than expected rates of de novo HCC in patients who achieved SVR with DAAs. 8-10 Purported mechanisms focused on a loss of immune control due to clearance of HCV-specific T cells from the liver . 11 These disturbing reports created quite a stir in the HCV community. However data from three distinct prospective French cohorts found no increase in HCC recurrence among those with SVR com pared with untreated individuals and more importantly, found decreased incidence of de novo HCC in patients with cirrhosis who achieved SVR. 12 At this year’s International Liver Congress, multiple groups reported on HCC occurrence and recurrence after DAA-based therapy, with no clear consensus. The studies were generally small and of varying quality, leaving clinicians uncertain of how to advise their patients. In short: the HCV community needed larger cohort studies. In the current issue, Kanwal et al. have provided just that and have likely closed the case on the HCC-occurrence issue post-SVR

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