Direct-Acting Antivirals Improve Survival in HCV-Related Liver Cancer: Presented at Liver Meeting

By Nancy Melville

BOSTON -- November 12, 2019 -- Patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) who achieve sustained virologic response with an oral direct-acting antiviral (DAA) show significant improvements in survival compared with patients with untreated HCV, according to a study presented here at The Liver Meeting, the annual meeting of the American Association for the Study of Liver Diseases (AASLD).

Patients with HCC who achieved sustained virologic response following treatment with DAAs had a median survival of 18 months, “which is considerable progress compared with other currently available systemic therapies for HCC,” said Mindie H. Nguyen, MD, Stanford University, Stanford, California.

The study included 1,676 patients with HCV-related HCC who were treated in the United States (n = 614) and Korea, Japan, and Taiwan (n = 1,062) between 2005 and 2017. Of the patients, 1,239 were untreated with DAAs.

After time-varying adjustment for the HCV treatment initiation time, the results showed that patients who achieved sustained virologic response with a DAA had significant increases in 5-year overall survival (87.78%) compared with those who were untreated (66.05%; PP

In a multivariable regression analysis, sustained virologic response was independently associated with as much as a 63% reduced risk of all-cause mortality (hazard ratio [HR] = 0.37; 95% confidence interval [CI], 0.16-0.83; P = .016) and a 76% lower risk of liver-related mortality (HR = 0.34; 95% CI, 0.13-0.88; P = .026).

“Our results clearly showed that sustained virologic response by DAA therapy is associated with improved overall survival, which is the most important endpoint for patients with cancer,” said Hidenori Toyoda, MD, Ogaki Municipal Hospital, Ogaki, Japan.

“Next, we should elucidate how sustained virologic response by DAA contributes to improved survival of patients with HCC,” he said. “Whether through the improvement of liver function, which in turn provides patients with more hepatic reserve, through both initial and repeat treatment, or through more direct effects that suppress the recurrence and/or progression of HCC.”

[Presentation title: HCV Cure by All Oral DAA Improves 5-Year Overall and Liver-Related Survival in HCV-Related HCC Patients: a Real-World, Propensity Score-Matched Study From Both East and West. Abstract 40]

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