Direct Acting Antivirals Safe, Effective for HCC Patients

Takamasa Ohki, MD, PhD

Direct-acting antivirals (DAAs) are a suitable options to treat hepatitis C virus (HCV) infections for hepatocellular carcinoma (HCC) patients.

A team, led by Takamasa Ohki, MD, PhD, Department of Gastroenterology, Mitsui Memorial Hospital, examined recurrence rates for HCC patients treated with DAAs.

Direct acting antiviral agents have transformed HCV care by altering liver function and reducing the recurrence rate following curative treatment in naïve hepatocellular carcinoma patients. However, it remains unknown whether this treatment class had a favorable effect on this patient group with multiple courses of recurrence.

“Direct acting antiviral agents (DAAs) improve HCV infection outcomes, even in patients with advanced liver disease, with a good safety profile and a sustained virological response (SVR) rate exceeding 90% in clinical practice,” the authors wrote.

The concerns over HCC recurrence became prominent in 2016, but subsequent trials found the risk is similar or possibly lower than what was observed in interferon-treated or DAA-unexposed controls.

The Study

In the study, the researchers retrospectively extracted 146 HCV-related HCC patients who received curative treatment using radiofrequency ablation (RFA) after eradication treatment with DAA between 2015-2017 and 184 patients who were curatively treated using RFA without hepatitis C eradication treatment between 2009-2014 as controls. The study and control groups did not differ significantly based on background demographics.

The team used propensity score matching method, which was adjusted based on age, sex, liver function, number of recurrence times, tumor diameter, and tumor numbers between the 2 groups.

The final analysis included 47 hepatitis C HCC patients with eradication of HCV and 47 control group patients, with a median age of 74,8 years old. In addition, 63.8% (n = 60) patients were male and 86.2% (n = 81) were Child-Pugh class A.

The median tumor number was 1, tumor diameter was 20 mm, and the frequency of recurrence was 3 times.

Primary Endpoints

The investigators sought primary endpoints of the time to curative treatment failure, defined as the interval from curative treatment initiation to premature discontinuation of this type of therapy.

The researchers compared clinical data, time to curative treatment failure, and overall survival and assessed the prognostic values of time to curative treatment failure and overall survival using multivariate Cox proportional hazard models.

Positive Results

The cumulative time to curative treatment failure rates of patients who received DAA were 93.6% and 73.2% at 1 and 3 years, respectively, compared to 72.5% and 37.1% for the control group (P <0.01).

The researchers did identify some independent factors that contributed to the time to curative treatment failure in eradication with DAAs (HR, 0.23; 95% CI, 0.12-0.43, P < 0.01), and DCP > 50 mAU/ml (HR, 2.62; 95% CI, 1.45-4.74; P < 0.01), after the conducted the multivariate analysis.

“Eradication of HCV using DAAs prolonged not only time to curative treatment failure but overall survival even in C-HCC patients with multiple courses of recurrence,” the authors wrote.

HCC is currently the second most common cause of cancer-related deaths globally, accounting for 780,000 deaths worldwide in 2012.

The study, “Effectiveness of direct acting antiviral agents for hepatitis C virus related recurrent hepatocellular carcinoma patients who had multiple courses of recurrence,” was published online in the Journal of Viral Hepatitis.