Liver Cancer post-hep C treatment

[lporterrn]

A few months back, some of us were alarmed to read about liver cancer risk post-hep C treatment. I just finished reading Alan Franciscus's snapshot about some recent research http://www.hcvadvocate.org/:

Article: Alcohol intake increases the risk of hepatocellular
carcinoma in patients with hepatitis C virus-related compensated
cirrhosis: a prospective study—A Vandenbulcke et al.
Source: J Hepatol. 2016 May 12. pii: S0168-8278(16)30184-2. doi: 10.1016/j.jhep.2016.04.031. [Epub ahead of print]
Study Aims and Results
The current study looked at the effect of alcohol consumption
and hepatitis C (HCV) treatment cure on the
risk of the development of liver cancer (hepatocellular
carcinoma (HCC)). The study authors collected information
on the amount of alcohol consumed by 192 HCV
p atients with HCV-related compensated cirrhosis.
Seventy-four patients consumed an average of 15 grams
of alcohol a day—the equivalent of a little more than one
12-ounce beer a day. Sixty-eight patients were cured
of HCV. The patients in the study were followed for an
average of 58 months. Thirty-three patients developed
liver cancer. Fifty-three patients experienced at least
o ne decompensation event (varices, asities, etc.,).
The 5-year cumulative incidence rate of liver cancer
was 10.6% in alcohol abstainers vs. 23.8% in alcohol
consumers. In persons who were treated and cured of
HCV, the liver cancer was 2.0% compared to 21.7% in
the patients not cured of HCV.
Those who did not drink alcohol and were cured of HCV
had the lowest incidence of liver cancer –0% followed by
t h ose who did drink alcohol but were cured of HCV (6.2%).
Patients who did not drink alcohol and who did not
achieve a cure of HCV had a cancer rate of 15.9%
compared to those who had consumed alcohol and not
c ured of HCV had a cancer incidence of 29.2%.
Importantly, it was noted that alcohol intake did not
i n fluence the risk of decompensation or death.
Editorial Comments
This was a small study, but it is important because it does
point to the fact that alcohol combined with HCV-related
cirrhosis can contribute to the development of liver cancer.
The people who drank alcohol in the study consumed
small amounts of alcohol. This study makes it clear that
p eople with cirrhosis should abstain from alcohol.
There is a need for more studies on the role of alcohol
and liver cancer.

Why this is important - these numbers are small (as were the post-treatment data showing risk of liver cancer), but it brings up the question that alcohol use may be the problem. Even a small amount raised the risk. This convinced me to recommend no alcohol use, even if one is cured.

[BillT]

I'm not sure you can tie the Hep C cures to this Lucinda.People with cirrhosis are much more likely to get liver cancer to begin with.If they're drinking on top of that they're playing with fire.It's a interesting study but I don't think it's really anything new.If the incidence of liver cancer in those that are non-cirrhotic went up after treatment then I would say new research would need to be done.   

[lporterrn]

I don't think we can tie them together, but I also think that we have to be careful about rushing to conclusions regarding the data we are seeing. Mostly I am making an appeal for open-mindedness.

[BillT]

I agree.These are new drugs so there's a lot of long term data that needs to be looked at.I know some people are having post treatment problems,but the majority of us coming out fine.Each and every one of us are handling these treatments differently.

[dragonslayer]

Kind of scary...  The cohort for this study was only patients who have cirrhosis, correct?

[lporterrn]

Yes, they all had cirrhosis. But if you look at liver cancer studies in general, alcohol use increases the risk. What is especially disturbing about this study is the amount of alcohol associated with the risk of liver CA was quite small.

[dragonslayer]

Yes, they all had cirrhosis. But if you look at liver cancer studies in general, alcohol use increases the risk. What is especially disturbing about this study is the amount of alcohol associated with the risk of liver CA was quite small.

Thats what impressed me; the tiny amount of alcohol required to cause these negative results... Ive been clear of virus for about a year and a half; both of my biopsies had me in the 0-1 stage, and I never was told I had any liver damage nor have any tests ever indicated liver problems other than the liver function tests which since treatment have been solid in the low normal range..... Ive felt pretty great since treatment ended, and hence, I've allowed myself the occasional beer.    The fact that Ive felt no ill effects from doing so has positively reinforced this behavior.   I feel that since all signs are normal, this behavior will have no worse effects for me and my liver than it would for the average joe..  Am I deluding myself?   My consumption would best be described as light to moderate  with moderate for men being described up to the equivalent of 2 beers/day, but I dont do this every day...  Thanks.

[lporterrn]

Honestly, I can't answer that. I am blessed by the fact that I can't drink for other reasons, and I don't know what I'd do if I could drink. These little joys, such an occasional beer, are part of life's pleasures. However, alcohol inflames, and does nothing to improve the liver, or cancer in general. I think we weigh the risks and decide what we can live with. You don't have cirrhosis, so the risk is likely small.

[Lynn K]

For me with well established cirrhosis diagnosed 8.5 years ago this just takes away the thought of maybe having a glass of champagne on any new years celebration

Maybe when I am 90

Cheers

[dragonslayer]

Hey Lynn.... I feel ya!  Any chance some of that damage will revert?  Ive read of some people having pretty amazing results...

While I was on treatment, and for about a year before, I abstained pretty much completely..  I had nothing on treatment, and for the year before, maybe had a total of 4 glasses of wine.   Im thinking one of the reasons my liver remained so relatively undamaged, considering I had the disease for near 40 years, since the early 70s, is that from about 1985 through about 2009, I didnt have a drop.   I had no idea I even had it until 2008 when I was diagnosed.. Interestingly, I was diagnosed with hepatitis back around 1972.  I turned yellow, peed brown, itched like a mosquito factory, and had to take a semester off from college.   I assumed it was hepatitis B, and I still carry those antibodies, but since my HCV diagnosis, Im thinking maybe that was when I got HCV infected as well.  My nefarious behavior continued on another couple of years after that 1972 diagnosis, so its possible I could have gotten it then, but all that behavior stopped in 1975.

So if longevity of infection were that predictive of liver health, Id be in the ground already...... While weaning myself off that bad behavior, I was drinking plenty regularly, but that pretty much stopped in 1985.

Maybe one day theyll figure out more precisely why two people with the same disease and the same behavior can have such different liver outcomes.

Best to you!

[Lynn K]

Thanks Paul

I was a moderate to occasionally heavy drinker until I was told on my Jan 08 biopsy I had cirrhosis. Stopped drinking then. With each biopsy over the years I went from F1 (1993) to F2 (1998) to F3 (2003) to F4.

I have some edema in my lower legs and I have had some ascities seen on ultrasound but that was not seen on my most recent one (yay) and I had esophageal varicies that required banding. My platelets were around 80 to 90 range but in last CBC they were up to 110. My pre treatment fibroscan was 27 (Oct 2014) my repeat fibroscan in April 2016 was 33.

I have read 50% with cirrhosis may regress some have said the odds are better than that so far I have had small improvements as shown by the platelet count and the ascities apparently gone but my fibroscan score not so much.

But none the less my liver is still limping along so if this is the best I can get I am fine with that as long as I don't get HCC I will be ok with what I have.

[FutureThinker]

One thing I've really learned to appreciate on this forum is just how totally amazing the liver is!!! I am hopeful that all of us get on to having normal lives with good liver function again. What a journey.......  FT

[Lynn K]

A lot depends on how much liver tissue remains and how much is totally dead scar tissue. In cirrhosis that is what occurs, healthy liver tissue is replaced by scar tissue that is incapable of regeneration so it all depends on how much viable liver tissue is available.

[FutureThinker]

You are absolutely right, and this is the primary reason this disease must be treated early, before significant fibrosis occurs!! This nonsense by the ins. industry asking most of us to "wait to get more sick" is just that -- malpractice and nonsense.  FT

[Lynn K]

And for those of us who treated before without success until these new medicines became available and already with cirrhosis we will just have to see what happens if we do have any improvement with time

[dragonslayer]

Just as early treatment is vital, so is early diagnosis.   If you dont know you have it, you cant alter your behavior accordingly, as of course, you should.    Just knowing about it at least gives you a fighting chance to mend your evil ways before your liver is trashed...  But without knowing, you dont really have a chance.   

[Lynn K]

Back when I was diagnosed with hep c my gastro said I could drink about 12 alcohol drinks a year and not all at once I was F1 then. Drank like that or less at times and at other times I did tie on on maybe half a dozen times over the years.

So it is what it is for me anyway...

[dragonslayer]

Back when I was diagnosed with hep c my gastro said I could drink about 12 alcohol drinks a year and not all at once I was F1 then. Drank like that or less at times and at other times I did tie on on maybe half a dozen times over the years.

So it is what it is for me anyway...

To me, that doesnt sound like all that much.   Truth is, you really dont know now much of a factor in your F4 status that was.. Dont beat yourself up too much about it; it might have had relatively little to do with it.

[Lynn K]

I just decided as there was no cure for me I just wanted to live my life who knows if it made any difference and all water under the bridge now any who

[gnatcatcher]

To me, that doesnt sound like all that much.   Truth is, you really dont know now much of a factor in your F4 status that was.. Dont beat yourself up too much about it; it might have had relatively little to do with it.

Yeah, Lynn -- no need to beat yourself up -- I got to F4 without drinking any alcoholic beverages

[Onefluover]

I made hundreds of gallons of "pruno" in the hole of San Quentin. I never once drank a single drop of it. I did it out of boredom and either flushed it or gave it to the guys down the tier. I didn't drink it because I have always viewed alcohol as poison. Not a delicious, harmless drink... This from a guy who on many occasions had to "tie off" several cellies by choking their necks so they could inject themselves with heroine into their jugglers because their other veins were wiped out. In my opinion, alcohol is no different than heroine. It's poison. It's just a couple steps from turpentine which will kill you almost instantly. Anyone who has had Hepatitis C and has had the grace to of been cured should never take the drug, alcohol, again. It is not our friend.