Data from a new study presented by Dang et al at The Liver Meeting (Abstract 40) found that patients with hepatitis C virus–related hepatocellular carcinoma (HCC) who achieved sustained virologic response (denoting an undetectable level of the virus) with any oral direct-acting antiviral therapy had over 60% to 70% improvement in 5-year survival. This improvement was found in both all-cause and liver-related cancers and was compared to patients with untreated hepatitis C virus. The study’s findings suggest that anyone with hepatitis C virus–related HCC who is a candidate for HCC therapy should also be considered for direct-acting antiviral therapy.

There is limited data on survival outcomes for patients with hepatitis C virus–related HCC following a hepatitis C cure with direct-acting antivirals. To address this lack of data, a multinational study was conducted by researchers in the United States, Korea, Japan, and Taiwan in order to compare survival rates in patients who achieved sustained virologic response with patients whose hepatitis C was untreated.

Methods

The study’s participants included 1,676 mono-infected patients with hepatitis C virus–related HCC: 614 were seen at two U.S. medical centers and 1,062 were seen at six medical centers in Korea, Japan, and Taiwan from 2005 to 2017. Patients were put into two groups: those untreated for hepatitis C and those treated for hepatitis C with direct-acting antivirals who achieved sustained virologic response.

There were 1,239 patients in the untreated group and 437 in the sustained virologic response group. The researchers matched and balanced the two groups based on a number of demographics, liver function, and HCC characteristics, and they evaluated survival rates taking into consideration when patients began treatment.

After patient-matching, the researchers ended up with 321 pairs of patients (321 untreated and 321 with sustained virologic response, all treated for HCC).

Findings

After time-varying adjustment for the hepatitis C treatment start time, patients with a sustained virologic response had significantly higher 5-year overall survival rates compared to those untreated for hepatitis C (87.78% compared to 66.05%). The sustained virologic response group also had higher liver-related survival compared to untreated patients (90.90% compared to 68.76%).

Sustained virologic response was independently associated with a 63% lower risk of all-cause mortality and a 76% lower risk of liver-related mortality, according to multivariate regression analysis. Further analysis at 90, 180, and 360 days also showed that achieving sustained virologic response with direct-acting antiviral therapy was independently associated with a lower risk of death compared to no hepatitis C treatment.

“Patients with [sustained virologic response] following treatment with very safe and well-tolerated direct-acting antivirals could increase their survival rates by a median of 18 months, [which is] considerable progress compared to other currently available systemic therapies for HCC. I believe the next important step is to study the current direct-acting antiviral utilization among [patients with HCC and how to optimize its use,” said the study’s senior author, Mindie H. Nguyen, MD, MAS, FAASLD.

Disclosure: For full disclosures of the study authors, visit aasldpub.onlinelibrary.wiley.com.