Antiviral treatments with a high genetic barrier to resistance, such as entecavir and tenofovir disoproxil fumarate, reduced the risk for hepatocellular carcinoma (HCC) recurrence in patients with hepatitis B virus (HBV) compared with other antiviral treatments, particularly in patients with a high viral load, according to data published in Journal of Viral Hepatitis.

Researchers from the Seoul National University College of Medicine, Korea, sought to evaluate whether high-potency nucleotide/nucleoside analogues, including entecavir and tenofovir disoproxil fumarate, reduce the risk for tumor recurrence better than low-potency nucleotide/nucleoside analogues after treatment of HBV-related HCC.

A total of 607 participants with HBV-related HCC treated with surgical resection or radiofrequency ablation were included in the study. Participants were categorized into 3 treatment groups: 261 participants received no antiviral medications, 90 participants received low-potency antiviral medications, and 256 participants received high-potency antiviral medications.

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The median recurrence-free survival was 29.4 months among participants receiving no antivirals, 25.1 months among those receiving low-potency antivirals, and 88.2 months among those receiving high-potency antivirals (P <.001). Participants receiving high-potency antivirals had significantly longer recurrence-free survival than those receiving no antivirals (hazard ratio [HR], 0.39; P <.001) or low-potency antivirals (adjusted HR, 0.47; P <.001). High-potency antivirals were also associated with longer recurrence-free survival after adjustments for baseline characteristics compared with no antivirals (adjusted HR, 0.46; P <.001) and low-potency antivirals (adjusted HR, 0.59; P =.007).

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Results showed that participants receiving high-potency antivirals had significantly lower risk for viral breakthrough than those receiving low-potency antivirals (HR 0.19; P <.001). Researchers also found that viral breakthrough was an independent risk factor for shorter recurrence-free survival among those receiving low-potency and high-potency antivirals.

“Our findings suggest that recurrence risk of HCC is increased in patients whose HBV DNA level is partially suppressed or who experience viral breakthrough even if HBV replication is subsequently suppressed by rescue therapy,” the investigators noted.


Cho H, Ahn H, Lee DH, et al. Entecavir and tenofovir reduce hepatitis B virus-related hepatocellular carcinoma recurrence more effectively than other antivirals [published online January 6, 2018]. J Viral Hepat. doi:10.1111/jvh.12855