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

Abstract

Our comprehensive review focuses on the treatment of hepatitis C virus in the context of hepatocellular carcinoma and vice versa, highlighting the ongoing complexity of this clinical scenario. There remain multiple unanswered questions when considering the management of these complex patients and, with a rapidly-changing treatment landscape for both chronic hepatitis C and hepatocellular carcinoma, these questions are only going to grow. Treatment timing, interactions and the impact of one disease condition on the other are vitally important, though guidance generally remains non-specific, suggesting that we make these decisions on a case-by-case basis. We focus on the current evidence for managing these cases, depending on disease stage and treatment type. BACKGROUND Hepatitis C virus (HCV) accounts for a third of all hepatocellular carcinoma (HCC) cases worldwide, with a 1%-8% annual risk of HCC development in cirrhotic HCV-infected patients [1-4] . The presence of cirrhosis greatly increases the risk of HCC development in HCV-positive patients, with the prominent pro-DECLARATIONS

Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of hepatocellular carcinoma

“…127 HBV infection is the etiological agent for as much as 50% of the incidence of HCC worldwide, 128 and HCV is estimated to account for up to one-third of cases. 129 HCV-associated advanced HCC was the first setting in which ICIs were evaluated, although modest response rates and a median time to progression of 6.4 months were observed in the initial study's 21-patient cohort treated with tremelimumab. 69 Adequate viral control was reported in hepatitis-infected, ICI-treated patients in CheckMate 040 and KEYNOTE-224, and no worsening of hepatitis was observed.…”

Unmet needs of chronic hepatitis C in the era of direct-acting antiviral therapy

“…10 In addition, with the breakthrough innovations of systemic therapy in advanced HCC, whether the treatment with DAAs and immunotherapy/target therapy alter the clinical outcome remains unknown. 34 Furthermore, the most critical point is whether HCV eradication will prolong long-term survival in patients with incurable HCC. Dang et al 35 conducted a propensity-matched study enrolling 1,239 untreated patients and 437 patients with an SVR.…”

“…Patients with active HCC may have more safety concerns during DAA treatment [ 10 ]. In addition, with the breakthrough innovations of systemic therapy in advanced HCC, whether the treatment with DAAs and immunotherapy/target therapy alter the clinical outcome remains unknown [ 34 ]. Furthermore, the most critical point is whether HCV eradication will prolong long-term survival in patients with incurable HCC.…”

Optimal Timing of Administration of Direct-acting Antivirals for Patients With Hepatitis C-associated Hepatocellular Carcinoma Undergoing Liver Transplantation

“…Offering DAA therapy prior to liver transplant allows for the treatment of HCV while the patient is on the waitlist, which reduces chronic hepatitis and may improve liver function. 34 Improvements in liver function due to DAA therapy, however, have not been shown to significantly impact waitlist priority or dropout rates. 35,36 Further, HCV exposure to the liver transplant surgical team is dramatically reduced.…”