Treating hepatitis C ‘feasible’ in patients with HCC, improves overall survival
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Failure to achieve sustained virological response and the presence of more advanced chronic liver disease were associated with mortality in patients with hepatitis C and hepatocellular carcinoma, according to a researcher at EASL Congress.
“It is well known that achieving a sustainable virological response after hepatitis C treatment reduces liver decompensation and HCC development with a positive impact on the overall survival,” Maria Fernanda Guerra Veloz, MD, PhD, of the Institute of Liver Studies at King’s College London, said. “All of these benefits in the reduction of liver-related morbidity/mortality and no liver-related mortality were already described in the interferon era and have resisted since across the whole spectrum of the disease with a direct-acting antiviral therapy.”
Veloz continued: “But what happened with patients with liver cancer and hepatitis C? It is important to mention that this population was not included in the clinical trials and so most of the evidence that we have is coming from retrospective and observational studies.”
In a real-world, single-center, retrospective cohort study, Veloz and colleagues aimed to evaluate virological response and overall survival among 98 adult patients (median age, 60 years; 53.7% men) with HCV-related HCC who underwent DAA treatment between 2015 to 2020.
Researchers stratified patients into a historical HCC cohort (17.3%), defined as HCC diagnosed and treated prior to 2015 with no evidence of active recurrence at the time of DAA therapy, and an active HCC cohort (82.7%) of patients with active HCC at the time of treatment. Veloz noted 84.7% of patients were cirrhotic with compensated liver disease, and 52% received curative treatment for HCC.
According to study results, the overall SVR rate was 82%, with 94% of patients in the historical cohort and 79% of patients in the active cohort achieving SVR. Among 18 patients who did not achieve SVR, active HCC (HR = 5.46; 95% CI, 1.25-23.82) and the number of HCC nodules (HR = 2.19; 95% CI, 1.08-4.41) were the only factors associated with failure to achieve SVR, according to multivariable analysis.
Further, results showed failure to achieve SVR (HR = 9.98; 95% CI, 2.16-46.01), the presence of Child Pugh B/C vs. Child Pugh A cirrhosis (HR = 3.73; 95% CI 1.46-9.58) and the administration of noncurative treatments (HR = 3.16; 95% CI 1.19-8.44) were significantly associated with mortality.
“Treating hepatitis C in patients with HCC is feasible and can achieve acceptable SVR rates,” Veloz concluded. “One-third of patients will require more than one DAA therapy.”
She added, “In our real-world data, overall survival was higher in those who achieved SVR.”
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Veloz MG, et al. Abstract OS-128: Achieving a hepatitis C cure in those with hepatocellular carcinoma is associated with an improvement in overall survival: Real world data. Presented at: International Liver Congress; June 21-24, 2023; Vienna (hybrid meeting).
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