Impact of direct-acting antiviral therapy for hepatitis C–related hepatocellular carcinoma

Abstract

With the introduction of direct-acting antiviral (DAA) agents, hepatitis C virus (HCV) treatment has dramatically improved. However, there are insufficient data on the benefits of DAA therapy in hepatocellular carcinoma (HCC). The purpose of this study was to investigate the outcome of patients who received DAA therapy after HCC treatment. We retrospectively reviewed patients with HCV-related HCC in a single medical center, and the outcome of patients with or without DAA therapy was analyzed. In total, 107 HCC patients were enrolled, of whom 60 had received DAA therapy after treatment for HCC. There were no significant intergroup differences in age, sex, laboratory results, or tumor burden. A more advanced stage was noted in the no DAA group (P = 0.003). In the treatment modality, sorafenib was commonly prescribed in the no DAA group (P = 0.007). The DAA group had a longer overall survival (OS) time than the no DAA group (P<0.001). When stratified by Barcelona Clinic Liver Cancer staging, the DAA group had better OS in the HCC stages 0-A and B-C (P = 0.034 and P = 0.006). There were 35 patients who received DAA therapy after curative HCC therapy. At a median follow-up of 20 months, 37.1% patients had HCC recurrence after DAA therapy. There was no statistical difference in recurrence-free survival between patients receiving and those not receiving DAA (P = 0.278). DAA therapy improved the survival outcome of HCC patients and did not increase recurrent HCC after curative therapy.

A Real-life Study of the Positive Response to DAA-based Therapies for Hepatitis C in Brazil

“…The rates of SVR were very satisfactory, 255 demonstrating that the treatment reached a high cure rate with an average of 95.5% with DAA 256 incorporated into SUS (87% to 100%), being the largest study carried out to date in Latin America. Similar data were found in other studies [9,19,20] .…”

Hepatocellular carcinoma after direct-acting antiviral hepatitis C virus therapy: A debate near the end

“…Similar results were found by Conti et al [ 14 ] in a single-center retrospective cohort study, with a recurrence rate of HCC after DAAs of 28.81%. Contrasting results were reported by Lin et al [ 59 ] in a recently published retrospective study which included 107 patients with HCV-related HCC, of whom 60 received DAA therapy after treatment for HCC. After a median follow-up of 20 mo, 37.1% patients had HCC recurrence after DAAs.…”

Antiviral therapy in the palliative setting of HCC (BCLC-B and -C)

“…Patients with BCLC-B/C HCC should have preserved liver function (Child-Pugh A or B 7 points without clinical ascites and/or encephalopathy) and all cirrhosis complications, such as variceal bleeding, under control. The limited published information [10,30,[34][35][36][37] regarding DAA treatment in this population is described in Supplementary Table 2. Chi et al, Ogawa et al, and Dang et al [35,37] were the only cohorts that reported SVR in BCLC-B/C/D patients ranging from 77.8-100%.…”