Tumor recurrence in patients treated with direct-acting antivirals for hepatitis C following curative therapy: a cause for concern?

Liver cancer is one of the most common malignancies in the world, the incidence ranking fifth in men and seventh in women and the mortality second for total number of cancer deaths worldwide (1). Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections accounts for over 80% of HCC diagnosed (2). Hepatocarcinogenesis promoted by HCV is a complex and progressive multistep process, whereby 80% of newly infected patients develop chronic infection; an estimated 10% to 20% develop cirrhosis and 1–5% progress to HCC over a period of 20 to 30 years (3). HCV induced tumorogenesis is believed to occur mainly indirectly, as a result of longstanding hepatic inflammation and fibrosis (most with HCV and HCC have established cirrhosis) and potentially also directly, by interaction of viral proteins with host oncogenes and pro-vascular factors (4).