HCV-HCC: study nixes link between DAAs, recurrence

  • Singal AG & al.
  • Gastroenterology
  • 17 Jan 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • A large, multicenter North American study has nixed any association between HCV direct-acting antivirals (DAAs) and risk for hepatocellular carcinoma (HCC) recurrence.

Why this matters

  • Findings also refute suggestions of a more aggressive disease course.

Study design

  • 31-center US/Canadian study of 793 patients with HCV-related HCC and complete response (CR) to resection, local ablation, trans-arterial chemo- or radioembolization, or stereotactic body radiation therapy during January 2013 through December 2017.
  • Median follow-up, 10.4 (interquartile ratio, 5.3-20.8) months.
  • Funding: National Cancer Institute, AbbVie.

Key results

  • 38.3% of patients received post-CR DAA therapy and 61.7% remained untreated.
    • Median time from CR to DAA therapy, 5.8 months.
    • Documented sustained virologic response rate, 81.8%.
  • HCC recurrence rate: 42.1% with DAAs, 58.9% without treatment.
  • Corresponding early HCC recurrence rates (≤365 days of CR): 17.1% and 46.4%.
  • In multivariate analysis, DAAs were not associated with HCC recurrence (HR=0.90; 95% CI, 0.70-1.16) or early recurrence (aHR=0.96; 95% CI, 0.70-1.34).
    • Analysis adjusted for study site, age, sex, Child-Pugh score, alpha-fetoprotein level, tumor burden, and treatment modality.
  • Most recurrences were within Milan criteria for both DAA-treated and -untreated patients (74.2% vs 78.8%; P=.23).

Limitations

  • Retrospective design.

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