Written by Peter Liu
Spoon Feed
Patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) had lower mortality when treated with tenofovir compared to patients treated with entecavir.
Tenofovir for HBV treatment confers survival benefit in HBV-related HCC
For patients with HBV infection warranting treatment, entecavir and tenofovir (either the old TDF or new TAF formulations) are the two nucleos(t)ide analogues that are currently first line treatments. Both therapies are thought to be highly effective, with the following considerations:
- Entecavir resistance is an issue in some patients.
- TDF does not have issues with resistance but has significant nephrotoxicity and negative long-term effects on bone density.
- TAF is a new tenofovir medication with lower side effects than TDF and similar efficacy for treating HBV, but there is less experience with this medication.
This adds to a growing body of literature that tenofovir-based treatments result in better prognosis for patients with both HBV and HCC. In a propensity-matched, retrospective cohort study analyzing 6,525 HBV-related HCC patients treated with either entecavir or tenofovir at a tertiary center in Korea (2008–2018; median follow-up 3 years), tenofovir therapy was associated with improved overall survival (65.4% vs 58.8%; HR 0.79; 95%CI 0.72-0.86; p < .001) and recurrence-free survival in patients treated for intent to cure their HCC (AHR 0.82; 95%CI 0.71-0.95; p = .006).
Several questions remain. First, how TDF confers a survival benefit is not well understood and may include entecavir resistance in the population, greater viral suppression unrelated to resistance by tenofovir, or other anti-inflammatory effects confirmed by TDF. Also, since TAF is a newer medication (e.g. approved in the USA for treatment of HBV in 2016), and not well-represented in the available HBV/HCC trials, it is not clear if TAF confers the same benefits as TDF.
How does this change my practice?
Overall, there is a growing body of evidence from East Asia that tenofovir therapy confers benefits greater than entecavir therapy for treatment of HBV-related HCC. As a result, I would advocate for the use of either TDF or TAF formulation in treating patients with HBV and HCC.
Source
Tenofovir Is Associated With a Better Prognosis Than Entecavir for Hepatitis B Virus-Related Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2025 Feb;23(2):300-309.e9. doi: 10.1016/j.cgh.2024.07.013. Epub 2024 Jul 31. PMID: 39089518
