Risk of Hepatocellular Cancer After Virological Cure with Direct Acting Antiviral Agents in Individuals with Hepatitis C
Abstract
Liver cancer is one of the deadliest cancers and is the fastest growing cause of cancer-related deaths in the United States. Despite new treatments, most patients who develop liver cancer die from it within 1 year of diagnosis. Chronic hepatitis C (CHC) infection is the main cause of liver cancer; hepatitis C is recognized as a high priority topic area by the Peer Reviewed Medical Research Program. The Veterans Health Administration has also recognized hepatitis C as a serious national health problem. The overall goal of this proposal is to reduce the burden of liver cancer in hepatitis C patients who achieve cure by new antivirals. The availability of new hepatitis C treatment, belonging to the class of direct-acting antivirals (DAAs), has made cure from hepatitis C a reality. Almost all patients with hepatitis C treated with these drugs are cured of their hepatitis C infection. However, the risk of liver cancer persists in patients who achieve cure from DAAs. Also, with the wide use of DAAs, the number of patients cured with these new drugs will rapidly increase in the near future. Therefore, effective prevention strategies are needed to prevent liver cancer-related deaths in these individuals. This research aims to fill gaps in our understanding of the risk of liver cancer and pros and cons of routine liver cancer surveillance in hepatitis C patients cured with new antivirals. We propose a large study of over 100,000 patients with hepatitis C in the national Veterans Administration (VA), one of the largest healthcare systems in the U.S, to identify the factors that increase or decrease the risk of liver cancer. We will then use this information to create a risk model that can be used to separate patients who are at a high risk from those at low risk for liver cancer. Additionally, this study will identify the long-term benefits and harms of liver cancer surveillance (CT scans, ultrasounds, MRIs, endoscopies, etc.) for patients with different risk factors (age, race/ethnicity, current liver condition, diabetes, obesity, lab reports, whether they have taken certain medications in the past, etc.). We will develop a computer-based, mathematical model (simHCC) that will predict the development and growth of liver cancer in patients with these different risk factors. We will use simHCC to identify the most effective treatment plans that are personalized to each patient’s individual risk profile. Finally, we will use the simHCC data to develop the first publicly available online tool (HCC Simulator) for doctors and their patients to use. The HCC Simulator will give real-time information (including graphic report printouts) on the risk of developing liver cancer, as well as effective treatment plans, all based on each individual patient’s risk factors. This tool will present the benefits and harms of surveillance procedures for each individual patient. Doctors and their patients will be able to use these printouts to discuss and make shared decisions about individual treatment plans.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910689
Entities
People
- Fasiha Kanwal
Organizations
- Baylor College of Medicine
- United States Army