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. 2019 Aug 7;3(10):1388-1399.
doi: 10.1002/hep4.1412. eCollection 2019 Oct.

Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV-TARGET Analysis

Kavita Radhakrishnan  1 , Adrian M Di Bisceglie  2 , K Rajender Reddy  3 , Joseph K Lim  4 , Josh Levitsky  5 , Mohamed A Hassan  6 , Jama M Darling  7 , Jordan J Feld  8 , Lucy Akushevich  7 , Monika Vainorius  7 , David R Nelson  9 , Michael W Fried  7 , Robert S Brown Jr  10 , Norah A Terrault  11
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Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV-TARGET Analysis

Kavita Radhakrishnan et al. Hepatol Commun. .

Abstract

Recent studies have suggested a negative impact of hepatocellular carcinoma (HCC) on sustained virologic response (SVR) to hepatitis C virus (HCV) direct acting antivirals (DAAs). We compared the effectiveness of DAAs in patients with cirrhosis, with and without HCC, and in those with HCC partially treated or untreated (PT/UT-HCC) versus completely treated (CT-HCC). HCC status was based on imaging 6 months before or 2 months after start of DAA therapy. Absence and presence of enhancing lesions after HCC treatment defined CT-HCC and PT/UT-HCC, respectively. Using minimally adjusted logistic regression, the association between the presence of HCC and SVR rates was estimated. Among the 1,457 patients with cirrhosis from HCV-TARGET with complete virologic data (per-protocol population) who did not undergo liver transplantation during treatment and followup, 1,300 were without HCC, 91 with CT-HCC, and 66 with PT/UT-HCC. Most patients were genotype 1 (81%) and treatment-experienced (56%), 41% had history of prior decompensation, and the median pretreatment Model for End-Stage Liver Disease was 9 (range 6-39). The SVR rates were 91% for patients without HCC, 84% for CT-HCC, and 80% for PT/UT-HCC. The presence of HCC (versus not having HCC) was associated with significantly lower odds of achieving SVR (odds ratio [OR] = 0.51, 95% confidence interval [CI]: 0.33-0.81; P = 0.003). However, among those with HCC, HCC treatment status (PT/UT-HCC versus CT-HCC) did not show association with SVR (OR = 0.79, 95% CI: 0.35-1.79, P = 0.569). Conclusions: The presence of HCC reduces the likelihood of SVR by 50%, but with no evident difference in those with completely treated HCC versus partially treated/untreated HCC.

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Figures

Figure 1
Figure 1
Consort diagram. Abbreviations: Disc, discontinued; EOT, end of treatment; LOE, lack of efficacy; OLT, orthotopic liver transplantation; TX, treatment.
Figure 2
Figure 2
SVR rates by HCC treatment status.
Figure 3
Figure 3
Multivariable predictors of SVR. **Estimated with Firth’s univariate logistic regression. *Estimated with Firth’s logistic regression, adjusted for decompensation. Abbreviations: LCL, lower confidence level; N Obs, number of observations; TBIL, total bilirubin; UCL, upper confidence level.
See this image and copyright information in PMC

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