Dallas, TX—How effective are new antiviral drugs for hepatitis C in reducing liver-related deaths in patients with a history of liver cancer?

A report in the journal Gastroenterology points out that mortality was reduced by nearly 50% in those patients. The findings are potentially practice-changing because of now-disproven concerns that the drugs could actually promote hepatocellular carcinoma recurrence.

The new study from the University of Texas Southwestern Simmons Comprehensive Cancer Center followed research in December by the same researchers, who found that antiviral drugs do not increase the risk of liver cancer recurrence, as was previously feared.

The research addresses concerns about using direct-acting antivirals to treat hepatitis C in patients with a history of liver cancer. The misconception, according to the study team, was the belief that hepatitis C activates the immune system and somehow lowers liver cancer recurrence.

The study reports that the drugs are safe and decrease 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,” lead author Amit D. Singal, MD, MS, explained. “Our study changes the paradigm from you could treat a patient's hepatitis C to you should treat it.”

Background information in the study notes the controversy over benefits of direct-acting antiviral (DAA) therapy for HCV infection for patients with a history of hepatocellular carcinoma (HCC).

The retrospective cohort study focused on patients with HCV-related HCC who achieved a complete response to resection, local ablation, transarterial chemo- or radioembolization, or radiation therapy, from January 2013 through December 2017 at 31 healthcare systems throughout the U.S. and Canada.

Of 797 patients with HCV-related HCC, 383 patients (48.1%) received DAA therapy and 414 patients (51.9%) did not receive treatment for their HCV infection after complete response to prior HCC therapy, according to researchers, who also report that, among DAA-treated patients, 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 DAA therapy (crude rate ratio, 0.23; 95% CI, 0.16-0.33).

The study found that, in inverse probability-weighted analyses, DAA therapy was associated with a significant reduction in risk of death (hazard ratio [HR], 0.54; 95% CI, 0.33-0.90). Furthermore, the association differed by sustained virologic response (SVR) to DAA therapy; risk of death was reduced in patients with SVR to DAA therapy (HR, 0.29; 95% CI, 0.18-0.47) but not in patients without an SVR (HR, 1.13; 95% CI, 0.55-2.33).

“In an analysis of nearly 800 patients with complete response to HCC treatment, DAA therapy was associated with a significant reduction in risk of death,” the authors conclude.

 « Click here to return to Weekly News Update.