Hepatitis virus variations responsible for variations in liver cancer

CHICAGO, IL—Significant clinical variations exist among patients with hepatocellular carcinoma (HCC), the most common type of liver cancer. These variations depend on the viral cause of the disease, which can be hepatitis B virus (HBV) or hepatitis C virus (HCV). These differences suggest that hepatitis status should be considered when developing treatment plans for patients with newly diagnosed HCC. These findings were presented at the 2015 American Society of Clinical Oncology (ASCO) Annual Meeting.

 “Currently, a patient's form of hepatitis is not a factor in treatment planning, but the two types of the virus result in different disease impacts and some variations in outcomes,” said principal investigator, Ahmed Kaseb, MD, associate professor, Gastrointestinal (GI) Medical Oncology at The University of Texas MD Anderson Cancer Center.

“Most likely, this is related to the difference in how hepatitis leads to cancer development, in addition to the differences in the natural history of both hepatitis forms. This might be the result of treating technically different diseases the same way. This study provides more evidence that future clinical trials should stratify patients by hepatitis type to help identify better drugs and create personalized treatment modalities.”

In the current study, researchers investigated detailed characteristics of 815 patients with HCC treated at MD Anderson between 1992 and 2011, assessing a range of disease-state variables and survival rates. HBV is a DNA virus and HCV is an RNA virus, and it has previously been unclear whether this difference might influence the clinical-pathologic features of HCC or patient outcomes.

Researchers found that patients with HBV were more likely to develop HCC at a younger age than HCV patients and presented more aggressive disease. The disease associated with HBV was found to be marked by advanced diagnosis stage (III-VI); high alpha-fetoprotein, a cancer signal and measure of how well treatments are working; poorly differentiated tumor cells, which tend to grow and spread more quickly; larger tumor size; extent of cancer in the liver ( >50% of the liver volume), a factor for metastases; and portal thrombosis, a blockage or narrowing of the vessel that brings blood to the liver from the intestines.

Patients with HCV-associated cancer were more likely to exhibit underlying cirrhosis, a history of greater alcohol and cigarette use, and a higher rate of diabetes.

The median survival rates were 10.9 and 9.3 months for HCV and HBV, respectively. At ASCO, the research team also presented the specific survival outcomes based on different therapies.

“Eligibility for certain treatments depends on cancer staging at diagnosis. Thus, this study has major implications for determining how we treat new HCC patients,” said Kaseb. “Especially for patients with HBV, we need to determine if more aggressive treatment is warranted at the outset.”

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