Recurrence rate of hepatocellular carcinoma in patients with treated hepatocellular carcinoma and hepatitis C virus-associated cirrhosis after ombitasvir/paritaprevir/ritonavir+dasabuvir+ribavirin therapy

United European Gastroenterol J. 2019 Jun;7(5):699-708. doi: 10.1177/2050640619841254. Epub 2019 Mar 29.

Abstract

Introduction: Recent studies have suggested a higher recurrence rate of hepatocellular carcinoma (HCC) in patients with a history of HCC and hepatitis C virus (HCV)-associated cirrhosis treated with direct-acting antiviral (DAA) agents.

Material and methods: We conducted a prospective analysis of 24 patients with HCV-associated cirrhosis and treated HCC who received ombitasvir/paritaprevir/ritonavir+dasabuvir+ribavirin for 12 weeks. Prior therapies for HCC included resection (9/24 patients), radiofrequency ablation (RFA) (7/24) and trans-arterial chemoembolization (TACE) (8/24). All patients were eligible for treatment if they had no HCC recurrence 6 months after their last procedure. A control group was defined. All patients were followed every 6 months, with dynamic computed tomography and/or magnetic resonance imaging.

Results: The sustained virological response rate per protocol was 21/24 (87.5%). The study group included 14 (59%) males, median age 64 years (51-77), 50% with associated non-alcoholic steatohepatitis and 24% with Child-Pugh A6 points. HCC recurrence rate/100 patient-years was lower in the DAA-HCC group versus control: 5.5 versus 24.6% patient-years for the resection+RFA group (p = 0.044), respectively, and 18.6 versus 72.7% patient-years for TACE group (p = 0.002). Survival without recurrence was higher in the resection+RFA group (45 compared to 18 months (p < 0.001)) and also in the TACE group (44 compared to 11.5 months (p = 0.002)).

Conclusions: DAA therapy significantly reduced the recurrence rate of HCC and improved survival without recurrence in patients with treated HCV-associated HCC.

Keywords: Hepatitis C; direct antiviral therapy; hepatocellular carcinoma; liver cirrhosis; ombitasvir/paritaprevir/r+dasabuvir+ribavirin.

MeSH terms

  • Aged
  • Anilides / therapeutic use
  • Antiviral Agents / therapeutic use*
  • Carbamates / therapeutic use
  • Carcinoma, Hepatocellular / complications
  • Carcinoma, Hepatocellular / therapy*
  • Chemoembolization, Therapeutic
  • Hepatectomy
  • Hepatitis C, Chronic / complications
  • Hepatitis C, Chronic / drug therapy*
  • Humans
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / drug therapy
  • Liver Cirrhosis / virology*
  • Liver Neoplasms / complications
  • Liver Neoplasms / therapy*
  • Macrocyclic Compounds / therapeutic use
  • Middle Aged
  • Neoplasm Recurrence, Local*
  • Prospective Studies
  • Radiofrequency Ablation
  • Ribavirin / therapeutic use
  • Ritonavir / therapeutic use
  • Sulfonamides / therapeutic use
  • Treatment Outcome
  • Uracil / analogs & derivatives
  • Uracil / therapeutic use

Substances

  • Anilides
  • Antiviral Agents
  • Carbamates
  • Macrocyclic Compounds
  • Sulfonamides
  • ombitasvir
  • Ribavirin
  • Uracil
  • dasabuvir
  • Ritonavir
  • paritaprevir