Breakthrough findings from a 2019 study show that not only is hepatitis C treatment safe but it is recommended for patients with a history of liver cancer – treatment can reduce the risk of liver-related death by approximately 50%.
In 2017, data from a study in Europe suggested patients with a history of hepatocellular carcinoma (HCC), the most common type of liver cancer, who had been cured of hepatitis C with antiviral drugs might have a higher risk of HCC recurrence. The hypothesis was that, for all its harmfulness, hepatitis C activated a patient's immune system when it infected the liver, keeping cancer recurrence at bay.
We know antiviral drug treatment can cure hepatitis C in more than 95% of cases, and we know that having chronic hepatitis C greatly increases the risk of cirrhosis of the liver – a major cause of liver cancer. Something wasn't adding up for our multidisciplinary liver cancer team at the Harold C. Simmons Comprehensive Cancer Center.
So, in winter 2018, we published our own study to explore the risks and benefits associated with hepatitis C treatment in patients with a history of liver cancer. We analyzed the medical records of patients cured of liver cancer at 31 North American medical centers, comparing patients treated for hepatitis C with direct-acting oral antiviral medications against those whose hepatitis C was not treated. After fully adjusting for other factors, we found no increased risk of liver cancer recurrence for previously cured patients who were treated for hepatitis C.
These findings led to another question and a groundbreaking discovery. We wanted to determine the extent to which hepatitis C treatment might impact a patient's risk of liver disease progression, thereby reducing the risk of liver-related mortality.
In summer 2019, we collected additional data on our multicenter cohort of patients and discovered that treating patients for hepatitis C reduces liver-related deaths by half. These findings were published in Gastroenterology in July 2019 and represent a paradigm shift in the treatment of patients with a history of HCC. Overall, our data highlight that not only can hepatitis C be treated in patients with a history of HCC, but it should be treated to preserve liver function and improve overall survival.
Local impact of Hepatitis C and chronic liver disease
Hepatitis C is one of the most common liver diseases in the U.S. and the Western world. An estimated 2.4 million people live with the disease, and approximately 70% to 85% of cases are considered chronic. The World Health Organization estimates that nearly 400,000 patients died from hepatitis C in 2016, mostly due to cirrhosis and HCC.
Texas has a high volume of aging patients who are living with hepatitis C. Many were infected in the 1980s or 1990s, and the infection can lie dormant for 25 years or longer before it begins to damage the liver. Texas is home to many people of Hispanic descent. Individuals with this ethnicity are at up to double the risk of developing infection-related cancers, such as liver cancer. Other factors for the high rates of liver cancer in Texas include a prevalence of obesity, diabetes, and a high rate of alcohol use.
'At UT Southwestern, we are well equipped to treat the potential complications of Hepatitis C including cirrhosis or liver cancer. We have a multidisciplinary liver cancer program that offers cutting edge treatment options and compassionate care as well as a large and robust liver transplantation program.'
There is currently no effective vaccine against hepatitis C; however, research in this area is ongoing. Over time, patients whose hepatitis C is not well controlled might develop cirrhosis, complications of cirrhosis, or HCC. In these patients, the risk of developing HCC compounds. Each year they live with chronic liver disease, their risk of developing HCC increases by 2% to 4%.
Providing hepatitis C treatment and diligent monitoring of patients' liver function is crucial to reduce the risk of developing incident or recurrent HCC. Patients should have an ultrasound examination and a blood test every six months to monitor their liver function. In patients who had liver cancer and were cured, we recommend an MRI or multi-phased CT scan every three to six months to watch for signs of potential recurrence.
Multidisciplinary care for patients
The Simmons Comprehensive Cancer Center and the Liver Transplant Program receive many referrals for the prevention and management of liver cancer treatment – both incident and recurrent cases. Our cancer center is one of just 32 U.S. cancer research centers named by the National Cancer Institute (NCI) as a National Clinical Trials Network Lead Academic Participating Site.
Only centers that meet rigorous standards for advanced cancer research can become NCI-designated. UT Southwestern is also home to one of the largest and most robust liver transplantation programs. Together, we care for patients awaiting liver transplants as well as those who have complex concurrent conditions such as decompensated cirrhosis from hepatitis C, alcohol-related liver disease, or non-alcoholic steatohepatitis.
As a multidisciplinary team, we approach patient care holistically with the goal of improving overall patient health along with their emergent liver condition. UT Southwestern continually pushes the boundaries of research in prevention and ongoing care. We anticipate that the profound findings from our research will usher in a new era in the care of patients with liver disease.
UT Southwestern welcomes referrals for patients with hepatitis C and others at risk for liver cancer or other complex liver diseases through the General Hepatology Program or the Liver Transplant Program. All patients will receive the most advanced care centered on their unique needs and the most current research in liver cancer prevention and treatment.
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