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Interferon-Alpha Reduces Liver Cancer Risk and Mortality in Cirrhosis Patients: Presented at AASLD

By Crystal Phend

SAN FRANCISCO, CA -- November 18, 2005 -- Sustained virological response from interferon-alpha treatment may reduce the risk of liver cancer and mortality in patients with hepatitis C (HCV)-related cirrhosis, researchers said here at the American Association for the Study of Liver Diseases annual meeting (AASLD).

Savino Bruno, MD, Head, Liver Unit, Hospital Fatebenefratelli e Oftalmico, Milan, Italy, and colleagues presented the largest study yet to examine whether sustained virological response reduces the risk of hepatocellular cancer (HCC).

The relationship between persistence of HCV replication and the development of HCC in patients with coexisting cirrhosis is still not fully understood, especially in Western populations, Dr. Bruno said.

Previous data showed interferon-alpha reduces the risk of liver cancer in hepatitis C patients, especially those who achieved a sustained virological response (Ann Intern Med. 2005 Jan 18;142(2):105-14.). However, it was not a randomized controlled study, so it remains unclear whether the benefit might be due to an overlapping association, Dr. Bruno said during the presentation on November 13^th.

Dr. Bruno and colleagues therefore conducted a retrospective study involving 23 referral centers in Italy. The cohort involved all of the centers' consecutive patients who had a clinical or histological diagnosis of cirrhosis that was treated with interferon monotherapy between 1992 and 1997.

Patients had Child's class A cirrhosis, the least severe of three cirrhosis classifications. None were co-infected with hepatitis B virus or HIV. The majority of patients had hepatitis C genotype 1 (55.3%).

Of the 1214 patients who received interferon-alpha, 16.4% achieved sustained virological response with no virus RNA detectable 24 weeks after treatment and persistent normalization of alanine aminotransferase levels.

HCC developed in 183 individuals (15.1%); 6.6% of these had cleared the virus and 93.4% were interferon non-responders -- about a three-fold difference in risk of HCC.

Significantly fewer patients who achieved a sustained response died during the follow-up period than did non-responders (5.5% vs. 16.7%).

Risk factors associated with death were lack of response to interferon-alpha (2.8-fold increase in risk), and diagnosis of HCC (5.1-fold increase in risk).

The increase in risk was even higher for liver-related mortality, which was 6.8 times higher for those diagnosed with HCC and 4.4 times higher for those who did not achieve a sustained virological response.

Based on their results, the researchers concluded that sustained virological response in patients treated with interferon-alpha reduced the risk of HCC and death.

"We believe that all patients with Child's class A cirrhosis who are suitable for treatment should be given this combination therapy," Dr. Bruno said.

However, he added, virological response did not eliminate entirely the risk of liver cancer. "We believe that you should continue surveillance," Dr. Bruno said.


[Presentation Title: Long-term Outcome of Patients With HCV-related, Child's Class A Cirrhosis Treated with Interferon-Alpha (IFN): The Impact of Sustained Virologic Response (SVR) on Hepatocellular Carcinoma (HCC) Occurrence and Mortality. Abstract 85]

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