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Entecavir 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.

Over 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.

The 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.

Results

• Patients with and without HCC had similar rates of treatment response during year 2 of entecavir treatment:
• Undetectable HBV DNA: 100.0% vs 95.4%, respectively;
• ALT normalization: 94.7% vs 97.3%, respectively;
• Hepatitis B "e" antigen (HBeAg) loss: 40.8% vs 41.8%, respectively.
• Entecavir treatment for 12 months decreased mean MELD liver disease severity scores in patients with cirrhosis and HCC (7.2 to 5.6).
• Among 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 survival.

Based 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 HCC patients."

"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.

6/28/11

Reference
Y-J 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).