New research finds direct-acting antivirals can be given safely to those on liver transplant waitlist.
Direct-acting antiviral (DAA) therapy in patients infected with hepatitis C virus (HCV) with hepatocellular carcinoma (HCC) can prevent recurrences for those on the transplant waiting list who have an initial response to locoregional therapy, according to a new study.
DAAs have been widely touted to cure HCV, but some controversy was raised recently when small, uncontrolled studies with only historical controls found an increased risk of HCC recurrence after treatment of chronic HCV.
“DAAs offer so much benefit in curing HCV. Our study confirms that DAAs are beneficial and should be used in patients on the transplant waiting list with HCC who have achieved initial response to locoregional therapy,” Annsa Huang, MD, resident in internal medicine at the University of California at San Francisco, told Medical Economics.
Huang presented data at a late breaking abstract (LBP-508) at the 2017 International Liver Congress.
The researchers conducted a retrospective cohort study of 178 liver transplant candidates with HCV and HCC. They compared 29 patients treated with DAA before HCC diagnosis and 62 patients treated after HCC diagnosis with 87 patients who did not receive DAA.
Compared with those who never received DAA therapy, patients treated with DAA before HCC diagnosis had lower one-year cumulative rates of HCC recurrence after complete response with locoregional therapy, and those treated with DAA after HCC diagnosis had similar recurrence rates.
In multivariate competing risk models, those treated with DAA before HCC diagnosis had similar risk of waitlist dropout, while those treated with DAA after HCC diagnosis had significantly reduced risk of dropout, as compared to those without DAA therapy.
Liver transplant rates were no different when DAAs were given before or after HCC diagnosis.
“The results show DAAs are protective for those who receive it before the initial diagnosis of tumor,” said Huang. “This aligns with the existing literature regarding improved sustained virologic response with newly diagnosed HCC.”
The study contributes to the literature in a different population - liver transplant patients on a waitlist. Waitlist dropout was due to tumor progression -- the tumor grew too large for the patient to remain on the waitlist -- or liver-related death, she said, highlighting that there was no worse outcome or increased rate of dropout in those who received DAA.
The researchers plan to do further analyses to confirm this results, in particular, to answer the question of why they found a lower risk of recurrence with DAA before HCC diagnosis. “We assessed recurrence rates and outcomes on waitlist. What are they after the patient receives a liver transplant? We also need to characterize the recurrence pattern,” said Huang.
She added: “We’ve shown DAA are still effective in treating HCC. They are safe to use in those with severe liver disease and should be considered for referral. Primary care physicians who see HCV patients with severe cirrhosis should continue using DAAs in these patients. If they have not initiated DAA therapy, they should consult with a hepatologist. The risk of HCC with DAA therapy is not high.”