When is the right time to treat hepatitis C in people with liver cancer?

Keith Alcorn
Published:
27 October 2019

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.

Glossary

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’.

regression

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 disease.

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 after treatment.

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 response.

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 cirrhosis.

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.”

References

Radhakrishnan K et al. Treatment status of hepatocellular carcinoma does not influence rates of sustained virologic response. An HCV-TARGET analysis. Hepatology Communications, 3 (10): 1388-99, 2019.

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