Impact of Hepatitis C Virus Eradication on the Clinical Outcome of Patients with Hepatitis C Virus-Related Advanced Hepatocellular Carcinoma Treated with Sorafenib

Abstract

Objective: To evaluate the impact of hepatitis C virus (HCV) eradication on the clinical outcome of patients with HCV-related advanced hepatocellular carcinoma (HCC) treated with sorafenib. Methods: A total of 58 HCV-related advanced HCC patients with Child-Pugh grade A disease who were treated with sorafenib were enrolled in this retrospective cohort study. Of these, 27 patients were HCV RNA negative as a result of previous antiviral therapy (sustained viral response [SVR] group), while the remaining 31 were HCV RNA positive (non-SVR group). Results: The response rate, disease control rate and median time to progression in the SVR group (6, 46.0%, and 3.8 months, respectively) were similar to those in the non-SVR group (3, 51.5%, and 2.7 months, respectively). On the other hand, the median time to treatment failure (TTTF), post-progression survival (PPS), and overall survival (OS) were significantly longer in the SVR group than in the non-SVR group (9.7, 8.5, and 15 months vs. 5.9, 5.2, and 9.3 months; p = 0.023, 0.02, and 0.014, respectively). On multivariate analysis, SVR was identified as a significant and independent determinant of PPS (p = 0.009), TTTF (p = 0.028), and OS (p = 0.01). Conclusion: HCV eradication before sorafenib treatment for HCV-related advanced HCC could prolong PPS and TTTF and improve OS.

Impact of chronic hepatitis C virus infection on the survival of patients with oropharyngeal cancer

“…4 Another finding in patients with advanced HCC was that eradication of HCV before the era of sorafenib improved OS and postprogression survival. 13 In addition, HCV-infected patients with diffuse large B-cell NHL had worse 5-year OS compared with those who were not infected with HCV. 15 The results of the current study demonstrated that HCV infection leads to a poor cancer prognosis in patients with OPCs after adjusting for potential confounders.…”

“…HCV infection negatively affects the oncologic outcomes of patients with or without HCV‐associated malignancies . For example, in patients with advanced HCC, underlying HCV infection was found to be associated with worse outcomes when compared with patients without HCV infection .…”

“…For example, in patients with advanced HCC, underlying HCV infection was found to be associated with worse outcomes when compared with patients without HCV infection . Another finding in patients with advanced HCC was that eradication of HCV before the era of sorafenib improved OS and postprogression survival . In addition, HCV‐infected patients with diffuse large B‐cell NHL had worse 5‐year OS compared with those who were not infected with HCV .…”

The oncologic burden of hepatitis C virus infection: A clinical perspective

“…Given the heterogeneity of these studies with respect to patient populations and performance status, the small numbers of patients studied in some groups, and the fact that HBV‐related HCC is more lethal than HCV‐related HCC, the impact of cancer therapy in HCV‐related versus HBV‐related HCC merits further study. Because HCV‐driven cirrhosis progression can make a patient with HCC ineligible for treatment, viral eradication before sorafenib treatment could improve oncologic outcomes, such as postprogression survival and overall survival, among patients with HCV‐associated advanced HCC . HCV‐infected patients are at risk for development of a second primary, HCV‐associated cancer after cancer treatment, including HCC and B‐cell NHL, if the infection is left untreated …”

Management of concomitant hepatocellular carcinoma and chronic hepatitis C: a review

“…This will include patients with decompensated liver disease and advanced hepatocellular carcinoma. For those with a better prognosis, HCV eradication prior to sorafenib treatment of HCC may prolong post-progression survival and improve overall survival [77] . Decisions regarding treatment timings should be considered on an individual basis, taking into consideration the advantages and disadvantages of treatment order [ Figure 3].…”