Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection Is Associated With Increased Survival in Patients With a History of Hepatocellular Carcinoma

Singal, Amit G.; Rich, Nicole E.; Mehta, Neil; Branch, Andrea D.; Pillai, Anjana; Hoteit, Maarouf; Volk, Michael L.; Odewole, Mobolaji; Scaglione, Steven; Guy, Jennifer; Said, Adnan; Feld, Jordan J.; John, Binu; Frenette, Catherine; Mantry, Parvez S.; Rangnekar, Amol S.; Oloruntoba, Omobonike; Leise, Michael D.; Jou, Janice H.; Bhamidimarri, Kalyan Ram; Kulik, Laura; Ioannou, George N.; Huang, Annsa C.; Tran, Tram T.; Samant, Hrishikesh; Dhanasekaran, Renumathy; Duarte‐Rojo, Andrés; Salgia, Reena; Eswaran, Sheila; Jalal, Prasun K.; Flores, Avegail; Satapathy, Sanjaya K.; Kagan, Sofia; Gopal, Purva; Wong, Robert J.; Parikh, Neehar D.; Murphy, Caitlin C.

doi:10.1053/j.gastro.2019.07.040

Cited by 142 publications

(138 citation statements)

References 35 publications

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“…[15][16][17] On the other hand, regarding DAA treatment, it is difficult to compare survival rates between SVR patients and non-SVR patients, as most patients (>90%) achieved an SVR with DAA treatment. Previous studies compared survival rates of DAA-SVR patients or DAA-treated patients with those of patients with untreated HCV, [19][20][21] but there was a selection bias for the induction of antiviral treatment when making comparisons with patients with untreated HCV. From this point of view, we selected IFN-SVR patients as a control group for DAA-SVR patients, and we compared overall survival rates between IFN-SVR and DAA-SVR patients.…”

Section: Discussionmentioning

confidence: 99%

“…These 10 variables were selected because they were reported to be related to HCC recurrence and were considered matching factors in previous studies. 19,20,22,28 ALBI grade was a liver function index, and FIB-4 index was a liver fibrosis index. 29,30 One-to-one PS matching was conducted by a nearest-neighbor method.…”

Section: Follow Upmentioning

confidence: 99%

“…[15][16][17][18] Recently, several studies reported that the overall survival rate was higher in DAA-SVR patients or DAA-treated patients than in patients with untreated HCV. [19][20][21] However, in these studies, pa-tients with untreated HCV were placed in the control group, and there was a selection bias for the initiation of antiviral treatment. Further studies are required to clarify the impact of DAA treatment on prognosis.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical outcomes of direct‐acting antiviral treatments for patients with hepatitis C after hepatocellular carcinoma are equivalent to interferon treatment

Tahata

Sakamori

Urabe

et al. 2020

Hepatology Research

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It remains unclear how direct acting antiviral (DAA) treatments influence hepatocellular carcinoma (HCC) recurrence and survival in comparison with interferon (IFN). Methods: In total, 338 patients with chronic hepatitis C virus (HCV) infection and previous HCC treatments who initiated IFN (N=88, IFN group) or DAA treatment (N=250, DAA group) from January 2005 to November 2017 at 23 hospitals and achieved sustained virologic response (SVR) were analyzed. Cumulative HCC recurrence and survival rates were compared between the two groups using propensity score (PS) matching. Results: After PS matching, 63 patients were selected for each group. The cumulative HCC recurrence rates at 1 and 3 years were 20.6% and 34.6% in the IFN group and 19.2% and 43.0% in the DAA group, respectively; the difference in cumulative HCC recurrence rates between the two groups was not significant (P=0.332). No significant differences in HCC recurrence patterns were observed between the two groups. Overall survival rates at 1 and 3 years were 100% and 96.6% in the IFN group and 100% and 96.4% in the DAA group, respectively; the difference in overall survival rates between the two groups was not significant (P=0.132). No significant differences in HCC recurrence and overall survival rates were observed between the two groups in subgroup analyses of patients receiving curative treatment (liver resection or radiofrequency ablation) for the most recent HCC before HCV treatment. Conclusions: The recurrence rates and patterns of HCC and overall survival rates do not differ between SVR patients receiving IFN and DAA treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Follow Upmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of direct‐acting antiviral treatments for patients with hepatitis C after hepatocellular carcinoma are equivalent to interferon treatment

Tahata

Sakamori

Urabe

et al. 2020

Hepatology Research

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“…Concern was transiently raised in 2016 that HCV might increase the risk of HCC recurrence after resection or ablation, 60 but that issue has been put to rest in a number of larger subsequent studies. 61,62 It is now clear that treatment of HCV does not have a significant impact on the course of established HCC (apart from improving outcomes as a result of halting the progressive deterioration of underlying liver function that would otherwise occur).…”

Section: Key Pointmentioning

confidence: 99%

Advances in resection and transplantation for hepatocellular carcinoma

Vibert

Schwartz

Olthoff

2020

Journal of Hepatology

128

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It would be impossible to summarise all of the significant developments in the surgical management of hepatocellular carcinoma (HCC), even just over the past year, in a manuscript of this scope. Thus, we have selected topics for discussion that are the subject of current controversy and have attempted to present balanced points of view. Hepatic resection and transplantation are both mature modalities, and for the most part technical advances and improvements in candidate selection are incremental. The ability to readily cure hepatitis C stands out as the most impactful development in the field over recent years, especially in Western countries where hepatitis C has long been the chief aetiology underlying HCC and a predictor of poor outcomes after surgery, but its full implications remain to be clarified. The rising incidence of non-alcoholic steatohepatitis-related HCC and what it means with regard to surgical HCC management is an area of great current interest. With advancing technology, non-surgical locoregional treatments are gaining increasing application as potentially curative therapies. In addition, the advances in molecular and genomic assessment of HCC hold promise for personalising treatment and prognostication. The possible role of immunotherapy as an adjuvant to resection is being aggressively investigated. While liver surgery maintains an important role, the care of patients with HCC is more and more a team effort and needs to take place in the context of a well-integrated interdisciplinary programme to achieve the best outcomes for patients.

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“…( 5 ) A follow‐up publication showed that the receipt of DAA therapy after the documentation of a complete response of HCC was associated with a 46% decrease in the hazard of death (hazard ratio, 0.54; 95% confidence interval, 0.33‐0.90). ( 6 )…”

mentioning

confidence: 99%

No Association Between Direct‐Acting Antivirals and Hepatocellular Carcinoma Progression on the Waiting List: Time to Put This Controversy to Rest?

John

2020

Liver Transpl

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The potential association between the receipt of direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV ) infection and the development of de novo or aggressive progression of hepatocellular carcinoma (HCC), surprisingly, continues to be debated, more than 3 years after first being raised in small single-center observational studies. (1)(2)(3) After initial studies without a concurrent control group described both an increased incidence of de novo HCC as well as more aggressive recurrence after curative anticancer therapy in patients with HCV who received DAAs compared with historic controls, several groups have explored this association in different populations across the world. (2,3) A review of the data shows that DAA therapy is not associated with the development of de novo HCC or aggressive progression of HCC after locoregional therapy, and follow-up studies have failed to corroborate the initial findings. (4) In a well-designed study, Singal et al. retrospectively analyzed a cohort of 793 patients with HCV-related HCC who achieved a complete radiological response following surgical resection, local ablation, transarterial chemoembolization or radioembolization, or radiation therapy across 31 North American centers. (5) They compared the incidence of posttreatment recurrence of HCC after complete radiological response between HCV-HCC patients who received DAA therapy and those who did not. The authors found that DAA therapy was not associated with an increased incidence of HCC recurrence and that HCC recurrence patterns were similar in DAA-treated and DAA-untreated patients. (5) A follow-up publication showed that the receipt of DAA therapy after the documentation of a complete response of HCC was associated with a 46% decrease in the hazard of death (hazard ratio, 0.54; 95% confidence interval, 0.33-0.90). (6) In this issue, Piñero et al. explore the association between DAA treatment and progression of HCC while on the transplant waiting list among 994 patients listed for transplantation across 20 centers in Latin America. (7) In addition to wait-list progression, they also looked at posttransplant recurrence of HCC. The authors compared 3 cohorts of patients with HCC listed for transplantation: those with HCC unrelated to HCV (n = 503), patients with HCV and HCC who did not receive DAAs (n = 327), and those with HCV and HCC treated with DAAs either before (n = 66) or after (n = 98) transplantation. A total of 81.9% were within Milan criteria, and the median time from listing to transplantation was between 6 and 9 months. The authors found that receipt of pretransplant DAA therapy was not associated with dropout from the transplant list or posttransplant recurrence of HCC.Why is this topic of interest to clinicians managing patients with HCC on the transplant waiting list? Transplant hepatologists have to consider a number of factors while deciding on the optimal timing of DAA therapy in HCV-HCC patients listed for transplantation. The benefits of treating HCV in patients on the waiting li...

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Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection Is Associated With Increased Survival in Patients With a History of Hepatocellular Carcinoma

Cited by 142 publications

References 35 publications

Clinical outcomes of direct‐acting antiviral treatments for patients with hepatitis C after hepatocellular carcinoma are equivalent to interferon treatment

Clinical outcomes of direct‐acting antiviral treatments for patients with hepatitis C after hepatocellular carcinoma are equivalent to interferon treatment

Advances in resection and transplantation for hepatocellular carcinoma

No Association Between Direct‐Acting Antivirals and Hepatocellular Carcinoma Progression on the Waiting List: Time to Put This Controversy to Rest?

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