Hepatitis C Virus Eradication Ameliorates the Prognosis of Advanced Hepatocellular Carcinoma Treated With Sorafenib

Akifumi Kuwano; Masayoshi Yada; Shigehiro Nagasawa; Kosuke Tanaka; Yusuke Morita; Akihide Masumoto; Kenta Motomura

Disclosures

J Viral Hepat. 2022;29(7):543-550. 

In This Article

Abstract and Introduction

Abstract

The risk of hepatocellular carcinoma (HCC) occurrence following hepatitis C virus (HCV) eradication has been previously reported, but the impact of HCV eradication on advanced HCC patient survival remains unclear. Therefore, the present study aimed to evaluate the effect of HCV eradication on the survival outcome of patients with advanced HCC treated with sorafenib. One hundred and three HCV-related advanced HCC patients who were treated with sorafenib were enrolled in this study. Of these, 43 patients were administered antiviral therapy before sorafenib treatment (HCV eradication group), while 60 patients remained HCV-infected (HCV non-eradication group). We analysed the impact of HCV eradication on survival in advanced HCC treated with sorafenib. Median overall survival (OS) was significantly longer in the HCV eradication group than in the HCV non-eradication group (24.0 months vs. 14.1 months; p = 0.001). Although there was no significant difference in the albumin-bilirubin (ALBI) score at the start of treatment between the HCV eradication group and the non-eradication group (p = 0.065), the ALBI score at 2 months after initiation of sorafenib treatment was significantly decreased in the HCV non-eradication group (p < 0.001), but not in the HCV eradication group (p = 0.121). Multivariate logistic analysis revealed HCV eradication (hazard ratio [HR], 0.5; p = 0.006) and ALBI score at the start of treatment (HR, 2.47; p = 0.002) as factors that may contribute to OS. HCV eradication may serve an important role in the survival outcome of advanced HCC patients treated with sorafenib.

Introduction

Hepatocellular carcinoma (HCC) accounts for 85%–90% of primary liver cancer cases.[1] Recent developments in systemic chemotherapy for advanced HCC such as molecular targeted agents have improved the prognosis of patients.[2,3]

Sorafenib is an oral multi-kinase inhibitor targeting, among others, VEGF receptor, RAF and PDGF receptor, thereby exerting both antiangiogenic and direct antitumor effects. Sorafenib has been shown to significantly prolong overall survival (OS) in patients with advanced HCC, resulting in a significant advance in the treatment of this disease. Sorafenib is approved worldwide and has become the standard treatment for patients with advanced HCC.[4,5]

An estimated 71.1 million people globally are living with chronic hepatitis C virus (HCV) infection, which carries the risk of progression to hepatic fibrosis, cirrhosis and HCC.[6] HCC risk increases 17-fold in HCV-infected patients compared with HCV-negative subjects.[7]

In previous decades, treatment of chronic HCV infection with interferon (IFN)-based regimens led to a cure in approximately 50% of treated patients.[8–10] With the recent introduction of direct-acting antivirals (DAAs), greater than 90% of patients at any stage of liver fibrosis may safely achieve sustained virological response (SVR).[11–13] SVR has been shown to substantially decrease the risk of HCC development. A retrospective cohort study of 22,500 HCV-positive patients treated with DAAs demonstrated that HCC occurrence was significantly reduced in patients with SVR compared with those without.[14] Although HCV eradication by IFN or DAAs reduces the incidence of HCC, and patients achieving HCV eradication have longer survival than untreated patients,[14–17] few reports have been published regarding the effect of HCV eradication on the prognosis of advanced HCC patients treated with molecular targeted agents.[18]

Here, we aimed to evaluate the effect of HCV eradication in advanced HCC patients treated with sorafenib.

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