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Direct-Acting Antiviral Therapy and Reduced Mortality in Patients With Hepatitis C and a History of Liver Cancer


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A study published by Singal et al in Gastroenterology demonstrated that treatment with antiviral therapy for hepatitis C reduced liver-related deaths by nearly 50% in patients with a history of liver cancer.

Previous Research

The finding builds on a December 2018 study by Singal et al also published in Gastroenterology that found that antiviral drugs do not increase the risk of liver cancer recurrence.

These studies overturn prior misconceptions that made doctors reluctant to prescribe direct-acting antivirals to treat hepatitis C in patients with a history of liver cancer. Many doctors previously believed that hepatitis C activated the immune system when it infected the liver, and the immune system kept liver cancer recurrence at bay. However, researchers studied nearly 800 patients from 31 medical centers across the country and found that the drugs are not only safe—but that they decreased death from cirrhosis and liver cancer by 46%.

“Not only are these drugs safe in this patient population, but we have now demonstrated that they are helpful,” said first study author Amit Singal, MD. “Our study changes the paradigm from you could treat a patient’s hepatitis C to you should treat it.”

Methods

Researchers conducted a retrospective cohort study of 797 patients with hepatitis C–related hepatocellular carcinoma who achieved a complete response through treatment with either resection, local ablation, transarterial chemoembolization or radioembolization, or radiotherapy.

Results

Of all patients included in the study, 48.1% (n = 383) received direct-acting antiviral therapy and 51.9% (n = 414) did not receive treatment for hepatitis C infection after complete response to prior liver cancer therapy. Among patients treated with direct-acting antiviral therapy, 43 deaths occurred during 941 person-years of follow-up, compared with 103 deaths during 526.6 person-years of follow-up among patients who did not receive direct-acting antiviral therapy (95% confidence interval [CI] = 0.16–0.33). 

KEY POINTS

  • Among patients treated with direct-acting antiviral therapy, 43 deaths occurred during 941 person-years of follow up, compared with 103 deaths during 526.6 person-years of follow up among patients who did not receive direct-acting antiviral therapy.
  • In inverse probability-weighted analyses, direct-acting antiviral therapy was associated with a significant reduction in risk of death.

In inverse probability-weighted analyses, direct-acting antiviral therapy was associated with a significant reduction in risk of death (95% CI = 0.33–0.90); risk of death was reduced in patients with sustained virologic response to direct-acting antiviral therapy but not in patients without a sustained virologic response.

The authors concluded, “In an analysis of nearly 800 patients with complete response to hepatocellular carcinoma treatment, direct-acting antiviral therapy was associated with a significant reduction in risk of death.”

Disclosure: For full disclosures of the study authors, visit gastrojournal.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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