Continued efforts are needed to aggressively screen, diagnose, and treat hepatocellular carcinoma (HCC) because patients with chronic hepatitis C and HCC may be less likely to achieve cure status than those without HCC, according to a systematic review and meta-analysis published in the Journal of Hepatology.1

Studies have demonstrated that antiviral therapy in patients with hepatitis B-related HCC can significantly reduce overall long-term mortality, even in patients with very advanced HCC or decompensated cirrhosis.2-5 Questions remain, however, about the effect of HCC on response to interferon-free direct-acting antiviral (DAA) therapy for patients with chronic hepatitis C compared with those without HCC.1 Therefore, researchers investigated the effect of DAA therapy on sustained virologic response (SVR) among 3341 patients with chronic hepatitis C and HCC and 35,701 patients with chronic hepatitis C but without HCC from 49 studies conducted in 15 countries. Overall, they found that SVR rates were lower in patients having chronic hepatitis C with HCC compared with patients diagnosed with chronic hepatitis C without HCC (89.6% vs 93.3%, P =.0012), which indicated a 4.8% SVR reduction. However, the largest SVR reduction (18.8%) occurred in patients with active/residual HCC compared with inactive/ablated HCC. Patients with HCC who had a prior liver transplant also had a higher SVR compared with patients with HCC who had not had a liver transplant (P <.001).

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When specific DAA therapies were evaluated, the researchers found that patients with HCC who were treated with ledipasvir/sofosbuvir had lower SVR rates than patients without HCC (92.6% vs 97.8%; P =.026). SVR was similar for patients with HCC who were treated with paritaprevir/ritonavir and ombitasvir±dasabuvir compared with patients without HCC (97.2% vs 94.8%; P =0.79), as well as patients with HCC who were treated with daclatasvir/asunaprevir compared with patients without HCC (91.7% vs 89.8%; P =.66).

“In conclusion, SVR was lower in HCC compared to non-HCC patients overall and especially in those with active HCC,” the authors concluded.1 In addition, “HCC treatment should be considered prior to DAA therapy whenever possible.”

References
1. Ji F, Yeo YH, Wei MT, et al. Sustained virologic response to direct-acting antiviral therapy in patients with chronic hepatitis C and hepatocellular carcinoma: A systematic review and meta-analysis [published online May 13, 2019]. J Hepatol. doi:10.1016/j.jhep.2019.04.017

2. Chong CC, Wong GL, Wong VW, et al. Antiviral therapy improves post-hepatectomy survival in patients with hepatitis B virus-related hepatocellular carcinoma: a prospective-retrospective study. Aliment Pharmacol Ther. 2015;41:199-208.

3. Chan SL, Mo FK, Wong VW, et al. Use of antiviral therapy in surveillance: impact on outcome of hepatitis B-related hepatocellular carcinoma. Liver Int. 2012;32:271-278.

4. Yang Y, Wen F, Li J, et al. A high baseline HBV load and antiviral therapy affect the survival of patients with advanced HBV-related HCC treated with sorafenib. Liver Int. 2015;35:2147-154.

5. Chen VL, Yeh ML, Le AK, et al. Anti-viral therapy is associated with improved survival but is underutilised in patients with hepatitis B virus-related hepatocellular carcinoma: real-world east and west experience. Aliment Pharmacol Ther. 2018;48:44-54.