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HCV cure improves survival in post-DAA liver cancer development

Patients who developed hepatitis C-related hepatocellular carcinoma after achieving sustained virologic response with interferon-free direct-acting antivirals had a 60% to 70% improvement in 5-year survival compared with untreated patients.

The results of the study come from a retrospective global analysis that included patient data gathered from the U.S., Japan, South Korea and Taiwan between 2005 and 2017.

“Using data from both North America and East Asia, we demonstrate that, compared to patients without HCV therapy, SVR obtained following treatment with DAAs are strongly and significantly associated with improved overall survival in patients with HCV-related HCC who also received therapy (palliative or curative) for HCC,” Hansen Dang, from the Stanford University Medical Center in California, and colleagues wrote.

The annual mortality incidence for 1,239 untreated patients was 7.7% (95% CI, 6.4-9.27) compared with 2.38% (95% CI, 1.28-4.43) among the patients who achieved SVR. Median survival was longer in the SVR group (44.32 months; 95% CI, 26.43-71.18) than the untreated group (26.09 months; 95% CI, 15.29-50.6), including a subgroup analysis of those who only received palliative treatment for HCC (27.39 vs. 19.66 months).

Specifically, the SVR group had lower rates of all-cause mortality (2.38%; 95% CI, 1.28-4.43) than the untreated group (7.7%; 95% CI, 6.4-9.27), and lower liver-related mortality rates (1.46%; 95% CI, 0.66-3.25) than the untreated group (7.02%; 95% CI, 5.76-8.57). By year 5 follow-up, more patients with SVR were still alive compared with the untreated group (87.78% vs. 66.05%), especially in liver-related mortality cases (90.9% vs. 68.76%; P < .0001).

Multivariate analysis revealed that SVR correlated significantly with a lower risk for all-cause mortality (HR = 0.37; 95% CI, 0.16-0.83) and liver-related mortality (HR = 0.34; 95% CI, 0.13-0.88).

“Our findings advocate for the consideration of treatment with IFN-free DAAs for patients with HCV-related HCC who are also treatment candidates for HCC, whether curative or palliative,” Dang and colleagues wrote. “The impact of SVR in HCV-related HCC patients who do not receive HCC treatment, who have Child-Pugh class C or [Barcelona Clinic Liver Cancer] above stage A, and who are younger than 50 years of age await additional investigation.” – by Talitha Bennett

Disclosures: The authors report no relevant financial disclosures.