Antiviral Therapy in Patients With Chronic Hepatitis C-related Hepatocellular Carcinoma Responding to Palliative Treatment

Yu, Jung-Hwan; Kim, Ja Kyung; Lee, Kwan Sik; Lee, Jung Il

doi:10.1097/mcg.0000000000000923

Cited by 5 publications

(8 citation statements)

References 28 publications

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“…While there is currently much discussion as to how aggressive clinicians should be about treating active HCV in HCC patients, no official guidelines currently exist. 23,26 Frequently, HCC management supersedes HCV treatment as many providers seek to triage HCV until after the cancer has been treated. 23 In addition, debate is ongoing as to whether or not DAA use increases HCC recurrence rates.…”

Section: Discussionmentioning

confidence: 99%

Impact of Direct Acting Antivirals on Survival in Patients with Chronic Hepatitis C and Hepatocellular Carcinoma

Kamp

Sellers

Stein

et al. 2019

Preprint

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26Direct-acting antiviral use is associated with increased survival in hepatitis C-related 27 hepatocellular carcinoma patients. Patients treated with direct-acting antiviral who achieved 28 hepatitis C cure had additionally increased survival versus those treated with direct-acting 29 antiviral who did not achieve hepatitis C cure. This study supports the use of direct-acting 30 antiviral for hepatitis C treatment in hepatocellular carcinoma patients. Abbreviations 53 DAA: Direct-acting antivirals; SVR12: 12-week sustained virologic response; HCC: 54 hepatocellular carcinoma; HCV: hepatitis c virus; OS: median overall survival; AJCC: American 55 Joint Committee on Cancer stage; MELD: Model for end stage liver disease; HR: hazard ratio 4 56 Abstract: 57 Background: To investigate the impact of direct-acting antivirals (DAA) and 12-week sustained 58 viral response (SVR12) in patients with hepatocellular carcinoma (HCC) and chronic hepatitis C 59 virus (HCV) infection. Methods: Retrospective analysis of HCC patients diagnosed from 2005 60 to 2016 at an urban tertiary-care hospital. Kaplan-Meier curves and multivariable Cox 61 proportional hazards models were used to assess survival. Results: 969 patients met inclusion 62 criteria. 478 patients received interventional oncology treatment (catheter-based therapies, 63 ablation or combination locoregional therapies), 141 received supportive care (palliative or no 64 treatment), 125 underwent liver transplantation, 112 had tumor resection and 94 received 65 chemotherapy or radiation as their primary treatment. Median overall survival of the cohort was 66 24.2 months (95% CI: 20.9-27.9). 470 patients had HCV (56%). 123 patients received DAA 67 therapies for HCV (26.2%), 83 of whom achieved SVR12 (68%). HCV-positive and HCV-68 negative patients had similar survival (20.7 months vs 17.4 months, p=0.22). Patients receiving 69 DAA therapy had an overall survival of 71.8 months (CI: 39.5-not reached) vs 11.6 months (CI: 70 9.8-14.5) for patients without DAA therapy (p<0.0001). DAA patients who achieved SVR12 had 71 an overall survival of 75.6 months (CI: 49.2-not reached) vs the non-SVR12 group (26.7 months, 72 CI: 13.7-31.1, p<0.0001). Multivariable analysis revealed AJCC, Child-Pugh Score, MELD, 73 tumor size, tumor location and treatment type had independent influence on survival (p<0.05). 74 In HCV-positive patients, AJCC, MELD, tumor location, treatment allocation and DAA were 75 significant (p<0.05). In patients receiving DAA therapy, only MELD and SVR12 were predictive 76 of overall survival (p<0.05). Conclusions: DAA therapy and achieving SVR12 is associated 77 with increased overall survival in HCV patients with HCC. 78 5 79

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Section: Discussionmentioning

confidence: 99%

Impact of Direct Acting Antivirals on Survival in Patients with Chronic Hepatitis C and Hepatocellular Carcinoma

Kamp

Sellers

Stein

et al. 2019

Preprint

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show abstract

“…Part of this may be due to the difficulty of integrating HCV treatment into HCC care, as demonstrated by the low rate of HCC patients with HCV receiving DAA treatment in our cohort (<50%). While there is currently much discussion as to how aggressive clinicians should be about treating active HCV in HCC patients, no official guidelines currently exist 23,28 . Frequently, HCC management supersedes HCV treatment as many providers seek to triage HCV therapy until after the cancer has been treated 23 .…”

Section: Discussionmentioning

confidence: 99%

“…Frequently, HCC management supersedes HCV treatment as many providers seek to triage HCV therapy until after the cancer has been treated 23 . In addition, debate is ongoing as to whether or not DAA use increases HCC recurrence rates 18,20,28–31 .…”

Section: Discussionmentioning

confidence: 99%

Impact of Direct Acting Antivirals on Survival in Patients with Chronic Hepatitis C and Hepatocellular Carcinoma

Kamp

Sellers

Stein

et al. 2019

Sci Rep

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With the increasing use of direct-acting antivirals (DAA) for treatment of chronic hepatitis C virus (HCV) infection, we looked at the impact of DAA use and 12-week sustained viral response (SVR12) in patients with hepatocellular carcinoma (HCC) and HCV. This is a retrospective analysis of 969 HCC patients diagnosed from 2005 to 2016 at an urban tertiary-care hospital. Kaplan-Meier curves and multivariable Cox proportional hazards models were used to assess survival. Median overall survival of the cohort was 24.2 months. 470 patients had HCV (56%). 123 patients received DAA therapies for HCV (26.2%), 83 of whom achieved SVR12 (67.4%). HCV-positive and HCV-negative patients had similar survival, 20.7 months vs 17.4 months (p = 0.22). Patients receiving DAA therapy had an overall survival of 71.8 months vs 11.6 months for patients without (p < 0.0001). DAA patients who achieved SVR12 had an overall survival of 75.6 months vs. 26.7 months in the non SVR12 group (p < 0.0001). Multivariable analysis revealed AJCC, Child-Pugh Score, MELD, tumor size, tumor location, cancer treatment type, receiving DAA treatment and achieving SVR12 had independent influence on survival (p < 0.05). This suggests DAA therapy and achieving SVR12 is associated with increased overall survival in HCV patients with HCC.

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“…Part of this may be due to the difficulty of integrating HCV treatment into HCC care, as demonstrated by the low rate of HCC patients with HCV receiving DAA treatment. There is currently much debate about how aggressive clinicians should be in treating active HCV in HCC patients and whether or not DAA use reduces the recurrence rate of HCC (43)(44)(45)(46)(47)(48). Recently, the American Gastroenterological Association (AGA) published a clinical practice update describing the interaction between DAA therapy for HCV and the HCC incidence, HCC recurrence, and DAA efficacy (49).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Antiviral Therapy for Hepatitis C Virus on the Survival of Patients after Hepatocellular Carcinoma Treatment

et al. 2022

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Objective Owing to advances in direct-acting antiviral (DAA) therapy, a considerable number of patients with hepatitis C virus (HCV)-positive hepatocellular carcinoma (HCC) are now able to achieve a sustained viral response (SVR) after curative treatment of HCC. However, the beneficial effect of a DAA-SVR on the survival remains unclear. Methods A total of 205 patients with HCC who were HCV-positive with Child-Pugh A at the onset from 2008 to 2018 were categorized into 2 groups: 140 patients untreated for HCV throughout the entire course after HCC development (untreated group) and 65 patients treated for HCV with DAAs following HCC treatment who achieved an SVR (SVR group). After propensity score matching, 63 patients from each group were selected. Using these patients, the survival and maintenance of Child-Pugh A after HCC treatment were compared between the untreated group and SVR group. Results There was a significant difference in the overall survival (p<0.001) and the rate of maintaining Child-Pugh A (p<0.001) between the groups. The 5-year survival rates were 96% (SVR group) and 60% (untreated group), and the proportions of patients with Child-Pugh A at 5 years after HCC treatment were 96% (SVR group) and 38% (untreated group). ConclusionIn patients with HCV-positive HCC, achieving a DAA-SVR after HCC treatment significantly improved the overall survival rate compared with HCV-untreated patients. The contribution of DAA-SVR during the course of HCC treatment to a longer survival is mainly due to the prevention of the progression of Child-Pugh A to B/C. Further research is needed to determine whether aggressive antiviral therapy is also effective for HCC patients with Child-Pugh B/C.

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Antiviral Therapy in Patients With Chronic Hepatitis C-related Hepatocellular Carcinoma Responding to Palliative Treatment

Abstract: Although treating HCV in HCC patient that undergo noncurative HCC treatment is still debatable, this study results carefully suggest that HCV-related HCC patients that responded to the initial HCC palliative treatment might benefit from HCV treatment.

Cited by 5 publications

References 28 publications

Impact of Direct Acting Antivirals on Survival in Patients with Chronic Hepatitis C and Hepatocellular Carcinoma

Impact of Direct Acting Antivirals on Survival in Patients with Chronic Hepatitis C and Hepatocellular Carcinoma

Impact of Direct Acting Antivirals on Survival in Patients with Chronic Hepatitis C and Hepatocellular Carcinoma

The Impact of Antiviral Therapy for Hepatitis C Virus on the Survival of Patients after Hepatocellular Carcinoma Treatment

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