Direct-acting antiviral treatment for hepatitis C need not
be delayed until the completion of treatment for hepatocellular carcinoma
(HCC; liver cancer), but people with hepatitis C need to be warned of a lower
likelihood of curing hepatitis C where liver cancer is present, a review of
treatment outcomes in the HCV-TARGET cohort shows.
The findings are published in the journal Hepatology Communications.
The HCV-TARGET cohort is a longitudinal, observational study
of people receiving hepatitis C treatment at 62 treatment centres in North
America and Europe.
- compensated cirrhosis
The earlier stage of
cirrhosis, during which the liver is damaged but still able to perform most of
its functions. See also ‘cirrhosis’ and ‘decompensated cirrhosis’.
- decompensated cirrhosis
The later stage of
cirrhosis, during which the liver cannot perform some vital functions and
complications occur. See also ‘cirrhosis’ and ‘compensated cirrhosis’.
Improvement in a tumour. Also, a mathematical model that allows us to measure the degree to which one of more factors influence an outcome.
To investigate the impact of HCC on hepatitis C treatment
response, HCV-TARGET investigators identified 1457 people with cirrhosis who
completed direct-acting antiviral treatment for hepatitis C, 1300 without HCC,
91 who had received treatment for HCC and had no evidence of an active tumour
at the time of hepatitis C treatment and 66 who had begun treatment or had no
treatment for HCC during the period they were undergoing hepatitis C treatment.
A majority of the study population was hepatitis C
treatment experienced (56%), male (645) and white (74%) and a high proportion
had a history of decompensated cirrhosis (41%), indicating advanced liver
HCC diagnosis was confirmed by imaging carried out no more
than six months before or two months after starting hepatitis C treatment. Completely
treated HCC was defined as no lesion present after treatment; partially or
untreated HCC was defined as lesions present during treatment or persisting
People with completely treated HCC (n=91) had been diagnosed
with cancer a median of 497 days prior to starting hepatitis C treatment;
people with incompletely or untreated HCC had been diagnosed a median of 377
days prior to starting hepatitis C treatment.
Hepatitis C cure rates were lower in those with HCC than
without. Whereas 91% of those without HCC achieved a sustained virologic
response after treatment, 83.5% of those with completely treated HCC and 80.3%
of those with incompletely or untreated HCC achieved a sustained virologic
Cure rates were highest in patients with no cancer who were
treated with sofosbuvir/ledipasvir with or without ribavirin (93.1%) and lowest
in those with untreated or partially treated HCC who received sofosbuvir and
simeprevir with or without ribavirin (73.7%). Compensated cirrhosis, lack of a
history of decompensated cirrhosis and a MELD score below 10 were associated with
the highest rates of hepatitis C cure in this population of people with
Multivariate regression analysis that adjusted for a history
of decompensation showed that the presence of HCC was associated with reduced
odds of being cured of hepatitis C (OR 0.51, 95% CI 0.33-0.81, p=0.003). But in
people with HCC, partial treatment or no treatment did not affect the odds of
achieving sustained virologic response.
“The clinical implications of these findings are 2-fold,”
conclude the study authors. “First, patients and providers need to set
expectation for SVR at a lower level for patients with SVR. Second, there is no
need to delay HCV treatment until after the HCC is treated, as the efficacy of
DAA treatment is not affected by whether HCC has been treated.”