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Fung et al. Hepatoma Res 2017;3:284-93 Hepatoma Research
DOI: 10.20517/2394-5079.2017.38
www.hrjournal.net
Topic: Management of Huge and Advanced Hepatocellular Carcinoma Open Access

The role of oral antiviral therapy in hepatitis

B-related hepatocellular carcinoma

James Fung 1,2,3 , Kenneth S.H. Chok 2,3,4

1 Department of Medicine, The University of Hong Kong, Hong Kong, China.
2 The Liver Transplant Center, Queen Mary Hospital, Hong Kong, China.
3 State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China.
4 Department of Surgery, The University of Hong Kong, Hong Kong, China.
Correspondence to: Dr. James Fung, Department of Medicine, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
E-mail: jfung@gastro.hk

How to cite this article: Fung J, Chok KSH. The role of oral antiviral therapy in hepatitis B-related hepatocellular carcinoma. Hepatoma Res
2017;3:284-93.
ABSTRACT

Article history: Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC) in places where
Received: 30 Aug 2017 chronic hepatitis B infection is endemic. Oral nucleos(t)ide analog (NA) therapy can reduce the risk
First Decision: 14 Sep 2017 of HCC, but cannot completely prevent its development. For HBV-related HCCs, viral inhibition
Revised: 3 Oct 2017 by NAs can preserve or improve liver function, thereby increasing the chance of therapeutic
intervention. After surgical resection, NAs can prevent reactivation of HBV, and also reduce
Accepted: 7 Nov 2017 the chance of de novo development of HCC in the remnant liver. For those who undergo liver
Published: 27 Nov 2017
transplantation, NAs are essential to prevent reactivation and graft hepatitis, but is not likely to
Key words: prevent HCC recurrence, which is due to metastatic disease. The role of NAs for non-curable
Antiviral therapy, advanced HCC is less well defined. These include patients undergoing locoregional therapy,
hepatitis B virus, chemotherapy, or palliation. Although antiviral therapy can preserve liver function, which may
hepatocellular carcinoma be compromised by HBV, it is unable to prevent disease progression from HCC. At the time
of HCC diagnosis, most patients will already be receiving NAs, and these patients should be
maintained on therapy. For patients not on antiviral therapy at the time of HCC diagnosis, the
decision to commence therapy is often determined by the stage of HCC and life expectancy.
Patients undergoing curative therapy, or locoregional therapy/chemotherapy with reasonable life
expectancy, should be commenced on antiviral therapy.

INTRODUCTION remains unclear, it is likely that HBV can promote the
[3]
oncogenic process both directly and indirectly . Direct
mechanisms include the integration of HBV DNA into
An estimated 240 million worldwide are currently the host genome, leading to genomic instability and
infected with the hepatitis B virus (HBV) and have malignant transformation . The integration of HBV
[4]
chronic hepatitis B (CHB) . In regions where CHB DNA into genes responsible for cellular proliferation
[1]
infection remains endemic, HBV remains the leading and differentiation may lead to uncontrolled cellular
[2]
cause of hepatocellular carcinoma (HCC) . Although proliferation via altered expressions of oncogenes
the exact mechanism of hepatocarcinogenesis and tumor suppressor genes. In fact, integrated HBV
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