Prevention is the only realistic approach for reducing mortality rates associated with hepatocellular
carcinoma (HCC). In this context, treatments which alter susceptibility to HCC or slow the progression of
hepatitis to cirrhosis have been advocated to prevent or delay the appearance of HCC. Two controlled studies in
Asia showed interferon and lamivudine to prevent or delay the onset of hepatitis B-related HCC, respectively.
However, prevention of HCC by interferon and nucleos(t)ide analogues in hepatitis B virus (HBV) patients has
been contradicted by several studies based on follow-up of patients with pharmacologically suppressed hepatitis
B. Interferon trials demonstrated a moderate reduction of HCC risk in patients with chronic hepatitis C who
achieved a sustained virological response, including cirrhotic patients. However, most studies were underpowered
to capture enough hard end points of the natural history of hepatitis C, having preferentially enrolled patients with
moderate liver impairment who have a better predicted compliance to interferon but a low risk of developing
HCC. Evidence for tertiary prevention of HCC is still inconclusive, due to poor methodologies and scientific
background of the studies.
Keywords: Hepatocellular carcinoma, chemoprevention, hepatitis C, hepatitis B, interferon, nucleoside analogues.
