SUMMARIES FOR PATIENTS
Interferon Therapy Improves Survival in Patients with Liver Cancer and Hepatitis C Virus Infection
18 February 2003 | Volume 138 Issue 4 | Page I-52
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The summary below is from the full report titled "Interferon Therapy after Tumor Ablation Improves Prognosis in Patients with Hepatocellular Carcinoma Associated with Hepatitis C Virus." It is in the 18 February 2003 issue of Annals of Internal Medicine (volume 138, pages 299-306). The authors are Y Shiratori, S Shiina, T Teratani, M Imamura, S Obi, S Sato, Y Koike, H Yoshida, and M Omata.
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What is the problem and what is known about it so far?
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Some infections of the liver are caused by hepatitis C virus (HCV). Hepatitis C produces scar tissue in the liver, a condition known as cirrhosis. Cirrhosis is closely associated with the development of liver cancer. Doctors have observed that the risk for liver cancer decreases when patients with HCV infection are given the antiviral medication interferon. However, liver cancer is very difficult to cure. One of the treatments used to treat liver cancer involves injecting the cancerous nodules with alcohol, which kills the tumor cells. But even after the tumor cells have been killed, the cancer tends to recur. Doctors don't know whether patients with HCV infection who already have liver cancer will benefit from interferon treatment in addition to alcohol injections.
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Why did the researchers do this particular study?
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They wanted to see if treatment with a combination of interferon and repeated alcohol injections into recurring tumors nodules could increase survival in patients with both HCV and liver cancer.
49 patients with mild HCV infection and three or fewer liver cancer nodules that had already been treated once with alcohol injections.
After the researchers confirmed that the tumor nodules had been destroyed by initial alcohol injections, all patients were followed to see if nodules recurred; additional alcohol injections were given when nodules were found. Two thirds of the patients also received treatment with interferon, and one third received alcohol injections without interferon. The researchers evaluated both groups to determine the timing of cancer recurrence and to see if survival rates differed between the groups. They also evaluated evidence for continued HCV infection with and without interferon treatment.
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What did the researchers find?
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The time to first recurrence of liver cancer did not differ in the two groups. However, second and third recurrences were less frequent in the patients receiving interferon. At 5 years after initial treatment, 68% of the interferon-treated patients were alive compared with 48% of the untreated patients. At 7 years, 53% of the interferon-treated group was alive compared with 23% of the untreated patients. Continuing HCV infection was greatly reduced in patients who received interferon; the virus persisted in all patients who did not receive interferon.
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What are the limitations of the study?
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Because the study is small and both patients and physicians knew the treatment regimen, results could have been unintentionally biased in favor of interferon treatment. Also, because participants had relatively mild HCV infections and mild liver abnormalities, the results cannot be used to predict outcomes in patients with more severe disease.
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What are the implications of the study?
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It may be possible to decrease the risk for liver cancer in patients with HCV infection by vigorously treating the infection.
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