HCV+ DLBCL: DAAs safe, effective during or after ICT

  • Merli M & al.
  • Oncologist
  • 14 Dec 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • HCV treatment with direct-acting antivirals (DAAs) is safe and effective when given either during or after first-line immunochemotherapy (ICT) for diffuse large B-cell lymphoma (DLBCL).

Why this matters

  • International guidelines recommend that DAAs follow ICT, based on limited evidence.
  • The current study supports concurrent or subsequent DAA administration.

Study design

  • French/Italian multicenter study of 47 consecutive patients with HCV+ DLBCL receiving DAA therapy with (n=9) or after (n=38) first-line ICT.
  • DAA regimens selected based on genotype; 45/47 sofosbuvir-based.
  • ICT was mainly rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)-like.
  • Funding: Fondazione Regionale Ricerca Biomedica, Fondazione Matarelli, Fondazione Rusconi, AIL Varese ONLUS.

Key results

  • Median patient age, 61 years; stage III/IV DLBCL, 89%; advanced fibrosis, 40%; cirrhosis, 25%.
  • HCV-1 (56%) and HCV-2 (34%) were most common.
  • 46/47 patients (97.9%) achieved complete response to ICT.
  • 45/47 patients (95.7%) achieved sustained virologic response at 12 weeks posttherapy (SVR12).
    • Concurrent DAAs, 88.9%.
    • Sequential DAAs, 97.4%.
  • DAAs were well-tolerated; 11 patients (23.4%) reported grade 1/2 adverse events.
  • Hepatotoxicity was lower with concurrent vs sequential DAA therapy (1 case [12.5%] vs 23 cases [61%]; grade 3/4, n=7).
  • 2-year progression-free and overall survival rates were 93.1% and 97.4%, respectively.

Limitations

  • Clinician selection of DAA timing.

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