A pragmatic trial of statins to prevent liver cancer in people with cirrhosis
People with cirrhosis have a high risk of liver cancer, and those who happen to take statins seem to get it less often. A proper trial would settle whether statins should be prescribed for prevention.
Large observational studies and meta-analyses associate statin use with substantially lower hepatocellular carcinoma incidence in cirrhosis and chronic hepatitis, with plausible mechanisms (reduced portal pressure, anti-fibrotic and anti-proliferative effects), and small randomised trials of simvastatin in cirrhosis show improved portal haemodynamics. No adequately powered prevention trial with cancer incidence as the endpoint has been completed. The proposal is a pragmatic randomised trial of atorvastatin or simvastatin versus placebo in compensated cirrhosis with HCC incidence as the primary outcome, run through hepatology networks and registries.
- No incentive to repurpose cheap drugs · Old, cheap drugs with anti-cancer signals never get the trials they need because no one profits from the result.
- Prevention we already have is not deployed · Around four in ten cancers are preventable with tools we already own: vaccines, tobacco control, weight, alcohol, sun and infection control.