“Hepatitis C virus (HCV) infection is a neglected disease in patients with cancer,” Harrys A. Torres, MD, and colleagues from the University of Texas MD Anderson Cancer Center in Houston noted in the Journal of the National Comprehensive Cancer Network. To rectify that situation, the researchers reviewed the records of HCV-infected patients with cancer seen at The University of Texas MD Anderson Cancer Center from 2008 to 2011 and analyzed the outcomes of those who were treated for HCV. “This is the largest series to analyze HCV infections in patients with cancer,” the investigators stated.
Of 1,291 patients who had positive test results for an antibody to HCV (anti-HCV), 744 (58%) were tested for HCV-RNA, and 642 of these patients (86%) were found to have had chronic HCV infections. Among these 642 patients, 68% were men; 65% were non-Hispanic white; 66% had genotype-1 (G-1) infections; and 72% had solid tumors, including 26% with hepatocellular carcinoma. “Complete remission of cancer was achieved in 223 patients (35%),” the authors noted.
A total of 348 patients received HCV therapy, 250 before and 98 after cancer diagnosis. Most of the 98 underwent combination therapy with peginterferon alfa-2a (PegIntron) and ribavirin. HCV therapy was frequently associated with adverse events (54%), mainly hematologic (74%), the researchers reported. Among the 78 patients with known treatment responses, sustained virologic response occurred in 27 (35%).
“Most treated patients were cancer survivors experiencing complete remission,” the authors noted. “No cancer survivors experienced a recurrence of the underlying cancer during HCV therapy. No patient experienced cancer progression within 1 year of HCV therapy, and only one experienced cancer relapse within 2 years after therapy. Selected chemotherapy agents, mainly hormonal, were concomitantly used with HCV treatment.”
Patients who did not experience a sustained virologic response were more likely than those who did to be black (29% vs 4%, P = .007), have G-1 infections (72% vs 6%, P < .0001), and higher baseline aspartate aminotransferase (78 vs 47 IU/L. P =.006) and alanine aminotransferase levels (71.1 vs 43.3 IU/L, P = .009).
“Overall, progression to cirrhosis (hazard ratio [HR], 0.38; P = .03) and portal hypertension (HR, 0.19; P = .009) was less common in those treated, irrespective of the treatment outcome (sustained virologic response or nonsustained virologic response). Hepatocellular carcinoma developed as a second primary malignancy in 7% of patients with nonhepatocellular carcinoma cancer,” the researchers reported.
The authors noted that treatment data for the study were collected until 2011, which was the year when direct-acting antivirals “such as the first-generation protease inhibitors telaprevir (Incivek) and boceprevir (Victrelis) were approved by the U.S. Food and Drug Administration.
In our experience,” the authors continued, “a triple combination—one of these two protease inhibitors combined with peginterferon alfa-2a and ribavirin—resulted in substantially higher sustained virologic response rates but also a higher incidence of side effects than dual therapy, as reported in patients without cancer. Peginterferon alfa-2a plus ribavirin are still used in cancer survivors with G-1 infection, especially if combined with recently approved direct-acting antivirals, such as sofosbuvir or simeprevir [Olysio]. In this population of patients, the use of interferon may be encouraged by some oncologists because of its anticancer activity.”
The authors concluded, “HCV therapy is feasible and prevents liver disease progression in this forgotten population.” The findings “also suggest that HCV-infected cancer survivors should not be excluded from participating in clinical trials of antiviral therapies while under surveillance for cancer recurrence.” ■
Torres HA, et al: J Natl Compr Canc Netw 13:41-50, 2015.