LBP-509
Occurrence and recurrence of malignancies post DAA Treatment in 5.1% of patients - single center experience
A. Issachar1, O. Sneh-Arbib1, M. Braun1, A. Shlomai1, E. Oxtrud1,
Y. Harif1, C. Karavani1, R. Tur- Kaspa1, M. Cohen-Naftaly1.
1Liver institute, Rabin Medical Center, Petah Tikva, Israel
E-mail:
assafissa@gmail.com
Background and Aims: Hepatocellular carcinoma (HCC) is an
ominous complication of hepatitis C cirrhosis. The risk of HCC is
reduced among patients cured from hepatitis C virus (HCV) with
interferon based therapy. Antiviral therapy with direct acting agents
(DAA) achieves cure of HCV infection (SVR) in over 95% of the
patients. Sporadic reports suggested that, contrary to the predictions,
an increase in HCC occurrence or recurrence was observed following
therapy with DAA, despite eradication of the virus.
Our aim is to analyze the occurrence and recurrence rate of HCC and
non HCC malignancies in our patients population, treated with DAA
for chronic hepatitis C.
Methods:We have conducted a retrospective study of a prospectively
maintained data base in our center. We reviewed 273 consecutive
HCV patients with or without previous history of HCC who were
treated with DAA, including transplanted patients and reached the
SVR12w.
Results: From July 2014 to January 2017, 273 patients were treated
with DAA and reached the 12 weeks post treatment. SVR was
achieved in 95.2% of the patients. Fourteen patients (5.1%) were
diagnosed with new malignancy between the end of the treatment
(EOT) and 18 months after the EOT (15 months post SVR12w). Six
patients (2.1%) had de novo HCC post treatment, three patients
(1.05%) had evidence of HCC recurrence post treatment. Interestingly,
one of those patients is a transplanted patient (for HCV cirrhosis and
HCC) who had no evidence of HCC in his explanted liver (4 years prior
to the DAA treatment), but developed metastatic HCC post DAA
treatment. Five patients (1.8%) developed non HCC malignancy: one
intrahepatic cholangiocarcinoma and 4 extrahepatic malignancies
(aggressive papillary carcinoma of the thyroid, Squamous cell
carcinoma of the skin, aggressive gastric carcinoma and Hodgkin’s
lymphoma).
Conclusions: Our data indicates an increased risk of malignancy, both
HCC and non HCC, in the first 18 months following DAA therapy. This
may support the theory of a sudden impairment of the immune
system allowing existing preclinical cancer clones to grow.
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