High Recurrence Risk for HCC Following Pegylated IFN Alpha-2b Plus Ribavirin

SAN DIEGO, CA—A prospective, multicenter study of patients with chronic hepatitis C and a history of hepatocellular carcinoma (HCC) treated with pegylated interferon alpha-2b plus ribavirin presented at IDWeek 2012 showed a high risk of recurrence that was especially profound in patients who did not achieve a sustained virologic response (SVR) with treatment.

Even after curative hepatic resection for HCC related to HCV infection, the rate of intrahepatic tumor recurrence within 1 year is 20% to 40%, increasing to approximately 80% by 5 years, according to lead study author Norihiro Furusyo, MD, Kyushu University Hospital, Fukuoka, Japan. Treatment with interferon can prevent recurrence of HCC and improve survival, especially for patients with SVR.

Since there are few reports of the use of pegylated interferon alpha-2b plus ribavirin treatment after curative treatment for HCC related to HCV infection, Furusyo and colleagues investigated the impact of this regimen in a prospective, multicenter trial of 84 Japanese patients with chronic hepatitis C with a history of HCC.

Patients with HCV genotype 1 (n=72) and 2 (n=12) were treated with peginterferon alpha-2b and ribavirin for 48 and 24 weeks, respectively. Subjects were observed for a median of 2.2 years (range 2–5 years) between 2005 and 2011. Rates of recurrence of hepatocellular carcinoma were calculated by treatment outcome: SVR, transient response (viral clearance during the treatment but subsequent relapse), and non-virological response.

A significant difference was observed between patients with HCV genotype 1 and 2. A SVR was seen in 23.6% of hepatitis C virus genotype 1 patients and 50% of hepatitis C virus genotype 2 patients. A transient response was seen in 47.2% of hepatitis C virus genotype 1 patients and 33.3% of hepatitis C virus genotype 2 patients. A non-virological response was seen in 29.2% of hepatitis C virus genotype 1 patients and 16.7% of hepatitis C virus genotype 2 patients.

During  the observation period, 67 patients had a recurrence of HCC, including 10 patients who had an SVR, 36 patients who had a transient response, and 21 patients who had a non-virological response. Among those whose HCC did not recur, 13 had an SVR, 2 had a transient response, and 2 had a non-virological response.

The 5-year cumulative rate of recurrence of HCC in the SVR group was 53.1%, lower than that of both the transient response group (87.7%; P=0.0353) and the non-virological response group (83.9%, P=0.4185). The 5-year cumulative rate of occurrence in the SVR group was significantly lower than the non-virological response group (P=0.0228).

The team concluded that univariate analyses of the pretreatment variables possibly related to the development of HCC were older age (P<0.0001), male gender (P=0.0049), higher ALT (P=0.0081), lower platelet count (P<0.0001), lower serum albumin (P=0.0018), and treatment outcome (P<0.0001).