Gut Liver.  2016 Nov;10(6):939-947. 10.5009/gnl15527.

Lamivudine versus Entecavir for Newly Diagnosed Hepatitis B Virus-Related Hepatocellular Carcinoma

• Kim JH
• Sinn DH
• Kim K
• Kim H
• Gwak GY
• Paik YH
• Choi MS
• Lee JH
• Koh KC
• Paik SW

• KMID: 2412100
• DOI: http://doi.org/10.5009/gnl15527

Abstract

BACKGROUND/AIMS
Antiviral therapy is a key component in the management of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients. However, whether the potent drug entecavir is more effective than a less potent drug, such as lamivudine, in HBV-related HCC is not clear.
METHODS
A retrospective cohort of 451 newly diagnosed, HBV-related HCC patients without antiviral therapy at diagnosis, who started antiviral therapy with either entecavir (n=249) or lamivudine (n=202), were enrolled.
RESULTS
The median survival was longer for the entecavir group than for the lamivudine group, and lamivudine use (vs entecavir) was an independent factor for mortality (hazard ratio [HR], 1.49; p=0.002). Lamivudine use (vs entecavir) was an independent risk factor for new-onset hepatic decompensation (HR, 1.67; p=0.010) in 318 patients without previous hepatic decompensation, and it was also an independent risk factor for recurrence after curative therapy (HR, 1.84; p=0.002) in 117 patients who received curative therapy. The findings were similar in a propensity score-matched cohort.
CONCLUSIONS
Overall survival, decompensation-free survival, and recurrence-free survival were better in the entecavir-treated patients than in the lamivudine treated-patients, indicating that the potent antiviral drug should be the preferred choice in HBV-related HCC patients.

Keyword

Antiviral agents; Hepatitis B, chronic; Carcinoma, hepatocellular; Potency; Survival

MeSH Terms

Adult
Antiviral Agents/*therapeutic use
Carcinoma, Hepatocellular/*drug therapy/virology
Female
Guanine/*analogs & derivatives/therapeutic use
Hepatitis B virus
Hepatitis B, Chronic/complications/drug therapy/virology
Humans
Lamivudine/*therapeutic use
Liver Cirrhosis/chemically induced/virology
Liver Neoplasms/*drug therapy/virology
Male
Middle Aged
Neoplasm Recurrence, Local/chemically induced
Propensity Score
Retrospective Studies
Risk Factors
Treatment Outcome
Antiviral Agents
Lamivudine
Guanine