Maintenance peginterferon therapy and other factors associated with hepatocellular carcinoma in patients with advanced hepatitis C

Abstract

Background & aims: Interferon reportedly decreases the incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C. The Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) Trial showed that 4 years of maintenance therapy with pegylated interferon (peginterferon) does not reduce liver disease progression. We investigated whether peginterferon decreases the incidence of HCC in the HALT-C cohort over a longer posttreatment follow-up period.

Methods: The study included 1048 patients with chronic hepatitis C (Ishak fibrosis scores ≥ 3) who did not have a sustained virologic response (SVR) to therapy. They were randomly assigned to groups given a half-dose of peginterferon or no treatment (controls) for 3.5 years and followed up for a median of 6.1 (maximum, 8.7) years.

Results: Eighty-eight patients developed HCC (68 definite, 20 presumed): 37 of 515 who were given peginterferon (7.2%) and 51 of 533 controls (9.6%; P = .24). There was a significantly lower incidence of HCC among patients given peginterferon therapy who had cirrhosis, but not fibrosis, based on analysis of baseline biopsy samples. After 7 years, the cumulative incidences of HCC in treated and control patients with cirrhosis were 7.8% and 24.2%, respectively (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.24-0.83); in treated and control patients with fibrosis, incidences were 8.3% and 6.8%, respectively (HR, 1.44; 95% CI, 0.77-2.69). Treated patients with a ≥ 2-point decrease in the histologic activity index, based on a follow-up biopsy, had a lower incidence of HCC than those with unchanged or increased scores (2.9% vs 9.4%; P = .03).

Conclusions: Extended analysis of the HALT-C cohort showed that long-term peginterferon therapy does not reduce the incidence of HCC among patients with advanced hepatitis C who did not achieve SVRs. Patients with cirrhosis who received peginterferon treatment had a lower risk of HCC than controls.

Trial registration: ClinicalTrials.gov NCT00006164.

Figure 1

Cumulative incidence of HCC; (A) by treatment assignment: peginterferon vs. control; (B) by treatment assignment and fibrosis strata (Ishak fibrosis stage 5 or 6 [cirrhosis] vs. Ishak 3 or 4 [fibrosis] at baseline); and (C) by treatment assignment and fibrosis strata for patients who were still at risk 3.75 years after randomization.

Figure 1

Cumulative incidence of HCC; (A) by treatment assignment: peginterferon vs. control; (B) by treatment assignment and fibrosis strata (Ishak fibrosis stage 5 or 6 [cirrhosis] vs. Ishak 3 or 4 [fibrosis] at baseline); and (C) by treatment assignment and fibrosis strata for patients who were still at risk 3.75 years after randomization.

Figure 1

Cumulative incidence of HCC; (A) by treatment assignment: peginterferon vs. control; (B) by treatment assignment and fibrosis strata (Ishak fibrosis stage 5 or 6 [cirrhosis] vs. Ishak 3 or 4 [fibrosis] at baseline); and (C) by treatment assignment and fibrosis strata for patients who were still at risk 3.75 years after randomization.