Improved Survival Seen in Hepatoma Patients After HCV Cure

By Will Boggs MD

November 28, 2019

NEW YORK (Reuters Health) - Cure of hepatitis C virus (HCV) infection with direct-acting antivirals is associated with increased survival in patients with HCV-related hepatocellular carcinoma (HCC), researchers report.

"The survival benefit was observed even in patients with fairly advanced HCC, patients who only received palliative care, and patients with advanced liver disease with cirrhosis," Dr. Mindie H. Nguyen from Stanford University Medical Center, in Palo Alto, California, told Reuters Health by email.

HCV is a leading cause of HCC worldwide, and systemic palliative therapies for HCC provide only a modest survival advantage compared with no treatment. Interferon-free direct-acting antivirals (DAAs) cure more than 80% of people infected with HCV, even those with advanced liver disease including HCC.

Dr. Nguyen and colleagues from eight medical centers in the U.S., Japan, South Korea and Taiwan evaluated the effect of DAA treatment on overall and liver-related mortality among patients with HCV and HCC who received either palliative or curative HCC treatment.

Among the 1,676 patients included in the study, 1,239 were never treated for their HCV and 437 achieved a sustained viral response (SVR) after DAA treatment. Propensity-score matching resulted in 321 pairs of matched patients.

The annual mortality incidence was significantly lower in the HCV-cure group (2.38%) than in the untreated group (7.70%), as was the annual liver-related mortality incidence (1.46% vs. 7.02%), the researchers reported in Hepatology, online October 14.

Median survival for the SVR (cure) group was 27.39 months, compared to 19.66 months for the untreated group. By year 5, 88% of SVR patients were still alive, compared with 66% of the untreated group.

After adjustment for other factors, SVR was associated with a significant 63% reduced risk of all-cause mortality, regardless of study region.

"I believe that, except for patients who are moribund or very terminal, patients with HCV-related HCC should be considered for DAA therapy," Dr. Nguyen said. "I hope care providers can now be encouraged to consider DAA therapies for their HCV patients and their patients can enjoy a significant survival benefit with a well-tolerated treatment; it is not too late to treat HCV even when HCC is already established."

Dr. Ashwani K. Singal of the University of South Dakota Sanford School of Medicine, in Sioux Falls, who recently reviewed HCV-related HCC as a leading indication for liver transplantation, told Reuters Health by email, "Although the data remained unchanged after removing 89 transplanted patients, data are needed on pre- vs. posttransplant treatment for HCV among patients eligible for liver transplantation as a basis for increasing deceased donor pool."

"Currently, the guidelines recommend not to treat HCV among advanced HCC patients with limited life span," he said. "But now with these data, studies are needed to examine benefit from HCV treatment in this group of patients, as well as pharmacogenomic studies to examine genetic-based differences in outcomes comparing Asians vs. non-Asians."

Dr. Nguyen and several of her coauthors report ties to manufacturers of direct-acting antivirals.


Hepatology 2019.