Antiviral Therapy Improves Hepatocellular Cancer Survival

Ngan Nguyen; Kruti Patel; Anna Carson Uhelski; Bradford Waters; Alva Weir

doi:10.12788/fp.0165

Antiviral Therapy Improves Hepatocellular Cancer Survival

Fed Pract. 2021 Aug;38(Suppl 3):e58-e63. doi: 10.12788/fp.0165.

Authors

Ngan Nguyen¹, Kruti Patel¹, Anna Carson Uhelski¹, Bradford Waters¹, Alva Weir¹

Affiliation

¹ is a Gastroenterologist in the Gastroenterology & Hepatology Department; and is a Hematologist Oncologist, Section Chief Hematology/Oncology, both at the Memphis Veteran Affairs Medical Center in Tennessee. is a Medicine Resident Physician at Johns Hopkins Osler in Baltimore Maryland. Bradford Waters and Alva Weir are Professors; and and are Hematology Oncology Fellows, all at the University of Tennessee Health Science Center, in Memphis.

Abstract

Background: Chronic hepatitis C virus (HCV) infection is a common risk factor for hepatocellular cancer (HCC). Patients with HCV infection are at a higher risk of developing HCC because the virus induces fibrosis in the liver, which may lead to cirrhosis. Early treatment of HCV and achieving a sustained virologic response (SVR) may lead to decreased incidence and mortality associated with HCC.

Methods: We performed a retrospective review of patients at the Memphis Veterans Affairs Medical Center (VAMC) in Tennessee from November 2008 to March 2019 to determine whether treatment of HCV infection makes a difference in overall survival (OS) among patients who develop HCC. Patients were treated with an interferon-based regimen or direct-acting antiviral agents (DAAs). Among the patients with HCV infection who were treated, we identified those who did achieve or did not achieve SVR.

Results: We identified 111 patients with HCV and HCC; 68 were treated for HCV infection. Forty-eight patients received DAA and 20 patients received an interferon-based regimen and 51 achieved SVR. In a multivariate analysis accounting for severity of liver disease, treated patients had an improved 5-year OS rate, median 1338 days (95% CI, 966-3202) when compared with untreated patients whose median OS was 452 days (95% CI, 242-853) (P = .0005). The treatment group had a longer median progression-free survival (PFS) than did the nontreatment group (460 days [95% CI, 294-726] vs 286 days [95% CI, 205-405], P = .04). Patients with SVR had an increased 5-year OS compared with patients without SVR (median 1973 days [95% CI, 1222-NA] vs 470 days [95% CI, 242-853], P < .001). HCV treatment type (interferon vs DAA) was not found to be associated with either OS or PFS, regardless of time period. Advanced liver disease stage as characterized by a high model for end-stage liver disease (MELD) score (> 10) or high Child-Pugh score (B or C) was associated with worse survival outcome.

Conclusions: A retrospective analysis of patients with HCV infection and HCC confirms that treatment of HCV infection leads to OS benefit among patients with HCC. We further demonstrate that patients with HCV infection who achieve SVR have an OS benefit over patients unable to achieve SVR. The type of treatment, DAA vs an interferon-based regimen, did not show a significant survival benefit.