Treating HCV after liver cancer: timing matters

Takeaway

• Most HCV+ patients with hepatocellular carcinoma (HCC) benefit from treatment with direct-acting antivirals (DAAs), but timing should be carefully considered.

Why this matters

• An increased risk for HCC recurrence has been reported post-DAA therapy, but in a small study; subsequent studies reported mixed results.
• Closer surveillance indicated for patients who received noncurative HCC therapy, received DAAs within 2 years of HCC care, or fail to achieve sustained virologic response (SVR).

Study design

• Nationwide retrospective Veteran’s Affairs (VA) cohort study of 264 HCV-infected patients who received DAAs an average of 30.9±20.6 months after successful HCC treatment (potentially curative, 28.8%; noncurative, 71.2%).
• Mean age at DAA initiation, 66.6±5.1 years; 49.2% were white and 40.3% were African American.
• Funding: Veteran’s Administration, VA Medical Center in Houston, TX.

Key results

• Over a mean of 23.3±9.8 months, 26.1% developed HCC recurrence.
  • Incidence rate: 0.38 per 1000 person-months.
  • Mean time to recurrence, 12.2±8.0 months.
  • 82.3% were early-stage.
• Noncurative HCC treatment was tied to a doubled risk for recurrence (aHR=2.06; P=.005), as was non-SVR (aHR=2.24; P=.02).
• HCC recurrence risk decreased with lengthening interval between HCC treatment and DAA therapy (per month: aHR=0.97; P=.006). Rates per 1000 person-months:
  • ≥4 years: 0.08.
  • 2-4 years: 0.37.
  • 1-2 years: 0.48.

Limitations

• Observational design, reliance on diagnostic codes.