TOPIC: DAAs and Liver Cancer Risk

Price my lymph cells changed during interferon plus riba therapy.
I'm sure others have had similar issues
I prefer to try not to think about these things it's very triggering.
I'm seeing my GP anyway today for a three week post EOT checkup.
That's from peginf too. Not from DAAs. Scared of having formed more tumours like the interferon gave me. In other places. Kidneys. Gut. Etc.
I'm okay now. I don't have HCC and that is another issue for more people and the advice here is to be vigilant as James said.
from Ariel

Hi Jill, let's do them now and more later.

Serg wrote:
Actually, it is believed that the anti-angiogenic effect of ribavirin was one reason why cancer recurrence was not seen with the old treatment.

P

Thanks Price, that was something I wondered about from the data I'd seen. So this is a great reminder that I had planned to review in more detail rather than just skimming.

I guess the current riba cohort size in the DAA reviews is too small yet to provide any confidence but my AFP has dropped to 4.5 under Tx. Maybe something there?

Hi Price and Gaj,

OOPS, my comments about Ribavirin may have more reflected my reaction to having to these findings raining on my parade then considered comment; though I do not have fond memories of Ribavirin at all...

On the issue of AFP's, these were the straw that helped send me onto treatment. Mine were always up with the specialist saying it was normal with chronic infection, but also noting that one time it also found a HCC. On treatment they went down for what it is worth.

One positive is that when they cry wolf again it may mean something and I can be worried then, rather then having maybes always in the back of my mind. Hearing your AFP's are down is good news Gaj.

Having Hep C and getting treatment for it feels like being on the pointy end of something - probably a needle when having bloods taken don't you think?

Yours

Jeff

Ariel:
I am a big believer in prevention and maximizing success. The bad thing is that usually nobody listens to me

Re : anxiety and stress
Someone very dear to me treated with interferon three times and ended up with severe stress intolerance and anxiety. He avoids anything that may be stressful. He no longer reads threads that may be upsetting and avoids people that create stress for him. Since I'm an advocate and I'm often involved in drama, I belong in that group. So I do understand.

I'm going after the answers. I've been researching the topic for months, Want to hear what I found out so far? Don't worry, it's optimistic!

Tomorrow I'll start a separate thread so I can tell you.

P.

"The Price is Right!

Hi Jeff, hopefully some of the rain from your parade falls into my glass (only just) half full, I could use it.

My understanding is that raised AFP can mean a lot of things but sudden increases are always worth close scrutiny. The drop is apparently probably good too but mostly gives me a low base to watch for increases over the next few months.

When you say "the pointy end" I believe you mean at the forefront of scientific research!

Could it be possible that people who took interferon are more at risk. How have they separated out this population from all the rest regarding hcc post DAA treatment as opposed to treatment naive post DAA and the occurrence of cancers ? Interferon is highly toxic , how can it not be linked, just a thought. Gloomy subject though. Jill

Hi Poodle,

my first posts were a stumbling way of asking for more information. I could not (read: am not smart enough) get too good an idea of 'who was who' among it all. For example how many were using ***, and of them how many those using *** did 12 vs 24 weeks, and who of them had a resection...., and how long ago....

And along the lines of what you say - this population compared to who? Maybe everyone else who previously had a HCC associated with the 4 hospitals (and who did not use DAAs) fared not too well either.

I expect that given the small numbers that would come out digging down that way, any results would not be really meaningful.

For me, it just raises alarm bells that are already well used anyway.

The way it is titled grabs some attention as well. I wonder what it might do to Gilead's share price if someone in the the USA publishes these findings using a similar title?


Yours


Jeff

We do need to be careful with what we read into this recent report. It is really an advisory of initial findings that may not be totally cohort neutral. Due to the retrospective nature of the study there may have been some selection in favour of those with HCC recurrence which is why additional study has commenced.

Also we should keep in mind something one of the study authors points out:


So for those with prior HCC who are now treating with DAAs it should act as an advisory to instigate careful and more regular than usual monitoring during the initial period post EOT.

Edit: yes Jeff you are correct about share prices, always look at the authors declarations of interest too.

Gaj,

puts it in a better context then I could.

And thanks for that. Yours


Jeff

Found an article called:

Hepatocellular carcinoma recurrence after treatment with direct-acting antivirals: First, do no harm by withdrawing treatment

by Harrys A. Torres, Jean-Nicolas Vauthey, Minas Platon Economides, Parag Mahale, Ahmed Kaseb

on the internet: www.journal-of-hepatology.eu/article/S01...(16)30248-3/fulltext

Abstract says:

We read with interest the article by Reig et al. [1] and applaud their pharmacovigilance efforts. However, because we work in a major cancer center in the United States, we are concerned about the consequences of the authors’ assumption that the use of direct-acting antivirals (DAAs) may induce hepatocellular carcinoma (HCC) relapse. This can affect not only the already cumbersome approval of DAAs for hepatitis C virus (HCV)-infected patients with HCC but also preclude patients with other cancers or HCV-associated malignancies (e.g., non-Hodgkin lymphomas) from receiving antiviral treatment associated with improved virologic, hepatic, and oncologic outcomes [2,3].

My assessment:

a) I hope the caution needed after the April 2016 stuff came to light does not lead to throwing the DAA baby out with the bath water.
b) if you had a HCC, don't think you can forget about it.

On another note,there is another I found:

Direct antiviral agents and risk for HCC early recurrence: much ado about nothing by Calogero Cammà, Giuseppe Cabibbo, Antonio Craxì. Ref: www.journal-of-hepatology.eu/article/S01...(16)30248-3/fulltext

My assessment: Keep your head down around researchers when they are in 'peer review' mode!

Nothing about HCC seems easy.


Jeff

Ty Sabrecat
Good to be vigilant in all areas
No HCC here just other stuff from peginf times. Will keep an eye on it already booked for colonscopy and cytoscopy
Cheers A

One study says yes....

"Unexpected early tumor recurrence in patients with hepatitis C virus -related hepatocellular carcinoma undergoing interferon-free therapy: a note of caution."

www.ncbi.nlm.nih.gov/pubmed/27084592

Another study says no.....

Lack of evidence of an effect of Direct Acting Antivirals on the recurrence of hepatocellular carcinoma: The ANRS collaborative study group on hepatocellular carcinoma (ANRS CO22 HEPATHER, CO12 CIRVIR and CO23 CUPILT cohorts).

www.ncbi.nlm.nih.gov/pubmed/27288051

P.