14 Interferon may exert a direct effect on cancer risk due to its antiproliferative activity. Finally, interferon may blunt the carcinogenic effects of viral replication or intracellular third viral proteins responsible for promoting cell growth, proliferation, and malignant transformation by suppressing viral replication.16 To address the lack of long-term follow-up data for combination therapy with interferon and ribavirin, our study sought to investigate the long-term clinical outcomes of responders and non-responders to combination therapy with interferon and ribavirin. However, the follow-up period of all subjects was not consistent or well-matched, as this was a retrospective study. The follow-up period was longer in the non-responders. Therefore, more follow-up data in responders is necessary for an exact comparison with non-responders.
According to this study, none of 57 SVR patients progressed to decompensated liver disease or HCC. However, only 2 patients (5.3 %) among the 38 relapsers progressed to HCC and 3 patients (7.0 %) among 43 nonresponders progressed to decompensated liver disease or HCC. This fact raised the possibility that standard interferon-based combination therapy decreased the risk of decompensated liver disease or HCC in the SVR group. However, it is uncertain whether interferon-based therapy that does not result in a SVR has an effect in slowing the progression of disease and the risk of HCC.14 Some studies reported that interferon had beneficial long term effects that reduced the occurrence of HCC, even in patients who did not have complete response to interferon.
17 In one such study, retreament with IFN to incomplete responders to previous IFN therapy appeared to have the additional effect of suppressing the development of HCC.15 That study suggested that IFN treatment had a suppressive effect on disease progression even in patients whose HCV was not eradicated with IFN. However, more studies should be conducted regarding the impact of interferon-based combination therapy on the long-term outcomes of HCV non-eradicated patients. The recent treatment of choice Entinostat for chronic hepatitis C has been pegylated interferon (PEG-IFN) plus ribavirin. In randomized-multinational phase III clinical trials, PEG-IFN plus ribavirin produced overall SVR rates of 56%16 and 63%17 in initial treatment patients with chronic hepatitis C, superior to the standard IFN plus ribavirin regimen. Therefore, further studies are warranted to determine whether better results for long-term clinical outcomes of HCV-infected patients can be achieved with a combination therapy consisting of PEG-IFN and ribavirin.