Direct-acting Antiviral Treatment for Patients With Hepatocellular Carcinoma

Tatyana Kushner; Douglas Dieterich; Behnam Saberi

Disclosures

Curr Opin Gastroenterol. 2018;34(3):132-139. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: Hepatocellular carcinoma (HCC) affects a significant portion of patients with hepatitis C. The use of direct-acting antiviral (DAA) agents has transformed the disease outcomes in this patient group.

Recent Findings: Hepatitis C virus (HCV) response to DAAs can be affected by the presence of HCC, whereas DAA therapy may affect the risk of HCC recurrence in patients with a history of HCC.

Summary: Emerging data are demonstrating lower sustained virologic response (SVR) rates in patients with HCC compared with patients without HCC. Conflicting studies have also suggested that rates of HCC recurrence in patients with a history of HCC can potentially be increased or decreased on DAA therapy. This review will provide a brief overview of these data and inform practitioners on important considerations to make when prescribing DAA therapy for patients with HCV and HCC.

Introduction

The use of direct-acting antivirals (DAAs) for patients with hepatitis C virus (HCV) has transformed the field of HCV treatment, with the vast majority of previously 'difficult to treat' patients, including those with prior treatment experience, genotype 3, coinfection with HIV, patients with kidney or liver transplants and advanced cirrhosis having cure rates of over 90%.[1] However, the data regarding potential treatment benefits versus risks of DAAs in HCV patients with hepatocellular carcinoma (HCC), or a prior history of HCC, are only now beginning to emerge and may impact future treatment recommendations in this patient population.

Prior to the approval of highly potent DAAs, the use of interferon in patients with HCC and HCV did not appear to lower sustained virologic response (SVR) rates[2] and was thought to reduce the incidence of secondary HCC due to antitumor properties of interferon, especially if patients achieved SVR.[3,4] However, the response of HCV to DAAs may actually be impacted by the presence of HCC or history of previously treated HCC. Furthermore, in the setting of treatment with DAAs, it has been suggested that HCC may occur or recur at higher rates.[5] Thus, for patients with active HCC, decisions regarding HCV treatment initiation need to be made in conjunction with the treatment plan for HCC. The use of DAAs in patients with HCC involves particular considerations compared with non-HCC patients. As such, this review focuses on the current knowledge surrounding the indication, effectiveness, and outcomes associated with DAA treatment in patients with HCC.

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