Impact of successful HCV treatment using direct acting antivirals on recurrence of well ablated hepatocellular carcinoma

ABSTRACT

Background

There are many contradictory studies that dealt with hepatocellular carcinoma (HCC) recurrence rate of well ablated hepatitis C virus (HCV) related HCC. We aim to assess the recurrence rate of previously ablated HCC in patients who received direct acting antiviral (DAA) for their HCV.

Research design and methods

This is a retrospective data analysis of 523 HCV patients who have a history of successfully ablated HCC and eligible for HCV treatment. Retrieval was done to demographic/clinical data, HCV pretreatment investigations, HCV treatment outcome. Follow up for survival and HCC recurrence was done every 3 months using abdominal ultrasound and alfa-fetoprotein.

Results

Mean age was 53.83 years. Sofosbuvir/daclatasvir/ribavirin was the most used regimen (35.4%) with 438 patients (83.7%) achieved sustained virologic response (SVR). The median duration for surveillance was 159 weeks. Hundred and five patients developed recurrent HCC, with a crude recurrence rate of 20.1%. There was no difference between HCV responders and non-responders in crude recurrence rate (p = 0.94) but HCC developed earlier in non-responders (p = <0.01).

Conclusion

Recurrence of HCC remains a threat in HCV patients even after achieving an SVR. Implementation of long-term surveillance programs is highly recommended.

KEYWORDS:

• HCV
• daas
• HCC
• recurrence
• SVR

List of abbreviations

ALT: Alanine aminotransferase

AFP: Alpha fetoprotein

AST: Aspartate aminotransferases

BMI: Body mass index

DAAs: Direct acting antivirals

DCV: Daclatasvir

FIB-4: The fibrosis 4 score

HBA1C: Glycosylated hemoglobin

HCV: Chronic hepatitis C virus

HCC: Hepatocellular carcinoma

IFN: Interferon

LED: Ledipasvir

LLOQ: Lower limit of quantitation

NCCVH: The National Committee for Control of Viral Hepatitis

PAR/OMB paritaprevir-ritonavir-ombitasvir

PEG: Pegylated interferon

RVB: Ribavirin

SMV: Simeprevir

SOF: Sofosbuvir

SVR: Sustained virological response

TACE: Trans-arterial chemo-embolization

Ethics approval

Approval was granted by the ethics committee of the national committee for control of viral hepatitis, Ministry of Health and population Egypt. All patients signed an informed consent before receiving treatment allowing the use of their anonymous data and results for publication.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they have received fees for lecturing from Gilead, BMS, Merck, Abbvie and for consulting and lecturing from Janssen. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Significance Statement

Patients with history of hepatocellular carcinoma (HCC) remain at risk of HCC recurrence even after receiving treatment by anti-HCV direct acting antivirals and achieving viral clearance. This necessitates to perform long-term follow up for these patients with a shorter time interval for early detection of any recurrent lesion.

Declaration of interest

Wahid Doss: investigator/speaker: Gilead Sciences. Gamal Esmat: investigator/speaker/advisory board member: Abbvie, Gilead Sciences, Marcyrl, Pharco, Roche. Imam Waked: Investigator/speaker/advisory board member: Abbvie, Eva Pharma, Gilead Sciences, Janssen, Marcyrl, Onxio, Pharco, Roche. The other authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties apart from those disclosed.

Author contributions

All authors have substantially contributed to the conception and design of the review article and interpreting the relevant literature, and been involved in writing the review article or revised it for intellectual content.

Additional information

Funding

This paper was not funded.