Effective for Hepatitis B Patients with Liver Cancer
Initial treatment with entecavir (Baraclude) monotherapy
worked well in chronic hepatitis B patients with hepatocellular
carcinoma, lowering viral load and improving liver health.
years or decades chronic hepatitis B virus (HBV) infection can lead
to serious liver disease including cirrhosis
and hepatocellular carcinoma (HCC).
Treatment with antiviral drugs can lower HBV viral load, potentially
clear the virus, and reduce the risk of liver disease progression,
but its effectiveness in people who already have advanced disease
has been less extensively studied.
As described in the May
18, 2011, advance online edition of the Journal of Gastroenterology
and Hepatology, Young-Joo Jin and colleagues from the University
of Ulsan in Seoul investigated the efficacy of the widely used drug
entecavir in patients with HBV-related hepatocellular carcinoma.
study included 231 treatment-naive chronic hepatitis B patients
who were primarily treated with 0.5 mg/day entecavir
monotherapy for at least 6 months. Within this group 71 people had
HCC at the start of entecavir therapy. Of these patients, 16 underwent
"curative" liver cancer therapy concurrently with entecavir
-- 6 hepatectomy (surgical tumor removal) and 10 radiofrequency
ablation (tumor destruction by radiation) -- while the remainder
received transarterial chemoembolization (injection of chemotherapy
drugs into the liver) or conservative treatment.
The researchers compared antiviral response to entecavir in patients
with and without HCC, as well as the effect of entecavir on clinical
outcomes among liver cancer patients treated with curative therapies.
with and without HCC had similar rates of treatment response
during year 2 of entecavir treatment:
HBV DNA: 100.0% vs 95.4%, respectively;
normalization: 94.7% vs 97.3%, respectively;
B "e" antigen (HBeAg) loss: 40.8% vs 41.8%,
treatment for 12 months decreased mean MELD liver disease severity
scores in patients with cirrhosis and HCC (7.2 to 5.6).
the 16 participants receiving curative liver cancer therapies,
those who achieved undetectable HBV viral load by week 24 had
significantly better overall survival, though not recurrence-free
on these findings, the study authors wrote, "First-line entecavir
monotherapy is comparably effective in chronic hepatitis B patients
with and without HCC, and improves hepatic function in HBV-related
"An early virological response to entecavir is prognostic of
improved survival following curative therapy against HBV-related
HCC," they added.
Investigator affiliations: Department of Internal Medicine, Asan
Medical Center, Asan Liver Center, University of Ulsan College of
Medicine, Seoul, Korea.
Jin, JH Shim, HC Lee, et al. Suppressive effects of entecavir on
hepatitis B virus and hepatocellular carcinoma. Journal of Gastroenterology
and Hepatology (abstract).
May 18, 2011 (Epub ahead of print).