Lower HCC risk with tenofovir over entecavir in chronic HBV
Patients with chronic hepatitis B virus (HBV) infection treated with the nucleot(s)ide analogue tenofovir disoproxil fumarate (TDF) had a lower risk of hepatocellular carcinoma (HCC) than those treated with entecavir, according to data from a large observational study presented at ILC 2019.
The study comprised 29,123 adults (mean age 53.7 years, 63.5 percent male) who initially received entecavir or TDF (n=27,896 and 1,227, respectively) for at least 6 months between 2008 and 2018. Individuals with a history of cancer or liver transplantation prior to or within the first 6 months of treatment were excluded. [ILC 2019, abstract LBO-03]
After a median follow-up of 3.3 years, nine (0.7 percent) TDF-treated individuals developed HCC, which was substantially lower than the number of participants who developed HCC in the entecavir arm (n=1,468, 5.3 percent).
The 5-year cumulative incidence of HCC remained lower in the TDF vs the entecavir arm (1.3 percent, 95 percent confidence interval [CI], 0.6–2.6 percent vs 7.5 percent, 95 percent CI, 7.1–7.9 percent).
TDF remained associated with a lower HCC risk than entecavir before (adjusted hazard ratio [adjHR], 0.46, 95 percent CI, 0.23–0.91; p=0.027) and after multiple imputation (weighted HR, 0.40, 95 percent CI, 0.18–0.86; p=0.019 [with propensity score weighting] and adjHR, 0.34, 95 percent CI, 0.18–0.66; p=0.001 [without propensity score weighting]).
According to the researchers, it is important to establish treatment alternatives for chronic HBV infection as this condition leads to liver inflammation, fibrosis, and cirrhosis, which could progress to decompensated liver disease and/or HCC. [Nat Rev Dis Primers 2018;4:18035] TDF and entecavir are both recommended as first-line therapy for HBV; however, current guidelines have not affirmed any preference for either drug. [Hepatology 2018;67:1560-1599; J Hepatol 2017;67:370-389; Hepatol Int 2016;10:1-98]
“[Our findings show that TDF] was associated with a significantly lower risk of HCC than entecavir in this large population of adults with chronic HBV infection,” said study investigator Dr Terry Yip from The Chinese University of Hong Kong in Hong Kong, China. Despite the inherent limitations of observational studies, the findings were consistent with those of a large Korean study reflecting a lower HCC risk with TDF vs entecavir, which further highlights the potential of TDF in reducing HCC risk, added Yip. [JAMA Oncol 2019;5:30-36; JAMA Oncol 2019;5:17-18]