Hepatocellular Carcinoma Decreases Chance of Successful HCV Therapy in the Current Era.
Gastroenterology and Hepatology, Northwestern University, Chicago, IL.
Meeting: 2016 American Transplant Congress
Abstract number: 107
Keywords: Efficacy, Hepatitis C, Hepatocellular carcinoma, Liver transplantation
Session Information
Session Name: Concurrent Session: Hepatic Malignancies
Session Type: Concurrent Session
Date: Sunday, June 12, 2016
Session Time: 4:30pm-6:00pm
Presentation Time: 5:06pm-5:18pm
Location: Room 304
Background: The efficacy of direct acting antiviral agents (DAA) for hepatitis C (HCV) in patients with hepatocellular carcinoma (HCC) is limited. We hypothesized that virology cure (SVR12) is lower among patients with HCC. Mechanisms may include HCC as a viral reservoir, higher portal hypertension, or altered drug metabolism due to HCC/therapies.
Aim: To investigate SVR12 in cirrhotics with and without HCC treated with DAA from 01/2014 to 11/2015.
Methods: Patients were identified via pharmacy records. HCV treatment (tx) included: ledipasvir/sofosbuvir (SOF) 12/24 weeks+/-RBV (n=80); 3D+/-RBV (n=5); SOF/RBV (n=23); SOF/Daclatasvir (n=2), simeprevir/SOF+/-RBV (n=96). Multivariate logistic regression assessed factors associated with SVR12 failure.
Results: Of 206 patients, 59 (28.6%) had HCC and 26 (12.6%) had liver transplantation (LT). Characteristics are shown in table1 SVR12 was lower among HCC patients (70.4% vs. 88.5%) than those without HCC (p=0.002). Univariate predictors of HCV tx failure were higher MELD, male gender, lower platelets, and presence of HCC (p<0.05 for all). In multivariate analysis adjusted for age, gender, MELD, platelets, prior HCV tx and genotype, only male gender (OR=3.46, 95% CI: 1.08-11.10, P=0.04) and presence of HCC (OR 3.3, 95% CI: 1.27-8.56, p=0.01) were associated with HCV tx failure. Among the 26 treated LT recipients, 18 were transplanted for HCC and 20 were treated post LT with 17 available for SVR12 analysis (3 on Tx). SVR12 rate was 93.3% in HCC LT recipients. In contrast, SVR12 rate in patients with tumor present (non-resected or pre-LT) was 50%.
Conclusion: HCC is independently associated with a higher rate of HCV tx failure. Tx response post LT for HCC was excellent. Further research is need to determine the optimal tx regimen and timing of HCV tx in patients with HCC, particularly among those eligible for LT.
|
Characteristic |
HCC (n=59) |
Non HCC (n=147) |
P VALUE |
|
Age, years, mean (SD) |
64.3 (7.8) |
61.1 (9.8) |
0.02 |
|
Male sex, % |
72.9 |
65.3 |
0.29 |
|
White race |
68.0 |
65.3 |
0.52 |
|
Body mass index (kg/m2) |
28.9 (5.3) |
28.9 (5.5) |
1.0 |
|
Calculated MELD |
12.4 (21.9) |
9.9 (4.3) |
0.20 |
|
Platelet (x106) |
146.4 (85.9) |
141.4 (100.9) |
0.74 |
|
Bilirubin (mg/dl) |
1.1 (0.67) |
1.2 (0.79) |
0.38 |
|
Log HCV viral load |
13.7 (1.7) |
13.7 (2.2) |
0.87 |
|
Prior HCV therapy |
65.5% |
62.3% |
0.74 |
|
Genotype, % 1 2 3 |
87.9 1.7 10.3 |
88.3 3.4 6.8 |
0.87 |
CITATION INFORMATION: Prenner S, VanWagner L, Kulik L. Hepatocellular Carcinoma Decreases Chance of Successful HCV Therapy in the Current Era. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Prenner S, VanWagner L, Kulik L. Hepatocellular Carcinoma Decreases Chance of Successful HCV Therapy in the Current Era. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/hepatocellular-carcinoma-decreases-chance-of-successful-hcv-therapy-in-the-current-era/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress