Systematic review with meta‐analysis: effectiveness of direct‐acting antiviral treatment for hepatitis C in patients with hepatocellular carcinoma

Abstract

Summary Background Direct‐acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection is highly curative and tolerable. Among patients with hepatocellular carcinoma (HCC), optimal timing of DAA therapy remains unclear. Data on efficacy of DAA therapy in patients with HCC would inform this decision‐making. Aim To evaluate response to DAA therapy among patients diagnosed with HCV infection and HCC. Methods Bibliographic databases and conference abstracts were searched. Meta‐analysis was conducted to pool sustained virologic response (SVR) estimates. Results Fifty‐six studies with 5522 patients with HCV and HCC were included. Overall SVR was 88.3% (95% CI 86.1‐90.4). Twenty‐seven studies included patients with prior or present HCC (n = 3126) and patients without HCC (n = 49 138), in which SVR was 88.2% (95% CI 85.0‐91.4) and 92.4% (95% CI 91.1‐93.7) among patients with and without HCC, respectively (odds ratio: 0.54, 95% CI 0.43‐0.68, P < .001). In the subgroup analyses, higher SVR was seen in patients who received curative HCC management (SVR 90.4%, 95% CI 88.3‐92.4), or treated with sofosbuvir + NS5A inhibitor DAAs (SVR 96.9%, 95% CI 94.3‐99.4), or in patients with HCV genotype 1 infection (SVR 92.0%, 95% CI 88.1‐95.6). Conclusion Response to DAA therapy was lower in patients with HCC compared to those without HCC, regardless of cirrhosis status. Among HCC patients, there was an impact of proportion with curative HCC management on DAA therapy response.

EASL recommendations on treatment of hepatitis C: Final update of the series☆

“…A higher SVR rate was observed in patients who received curative HCC therapy than in those who received non-curative therapy or were not treated. 225 In a retrospective cohort study of 149 liver transplantation candidates with HCV infection and HCC at a single centre, patients treated with DAAs for their HCV infection had lower risk of waitlist dropout due to tumour progression or death compared to the patients who had not been treated. 226 Post-liver transplantation treatment of HCV was reported to be cost-effective in patients with HCC.…”

Decompensated cirrhosis and liver transplantation negatively impact in DAA treatment response: Real‐world experience from HCV‐LALREAN cohort

“…In the multivariate analysis, active HCC (vs inactive HCC and non‐HCC) was associated with DAAs failure (OR, 24.5 [95% CI, 4.4‐136.9], P < .001) 27 . Two recently published meta‐analysis confirmed a reduced SVR rate in patients with active HCC when compared with patients with inactive HCC or without HCC 28,29 …”

Recommendations of the Polish Group of Experts for HCV for the treatment of hepatitis C in 2020

“…Their authors raise beneficial effects, but only from the point of view of the sustained virological response (SVR) obtained, not precisely referring to results of cancer treatment. Evaluation of long-term results of DAA therapy in this group of patients is necessary [ 23 - 25 ].…”