Hepatocellular carcinoma recurrence rates and patterns did not differ between patients who underwent interferon-based antiviral therapy for hepatitis C and those who received direct-acting antiviral therapy, according to a recently published study.
“With the development of direct-acting antivirals (DAA), patients with a history of HCC can achieve a high sustained viral response (SVR) rate with favorable tolerability,” Mizuki N. Kinoshita, MD, from the University of Tokyo, and colleagues wrote. “However, a high rate of early tumor recurrence has been reported in patients with a prior history of HCC treatment who were starting DAA treatment, for which we have presented counterevidence.”
The retrospective study comprised 303 patients with HCV, 156 of whom received interferon-based therapy and 147 of whom underwent DAA therapy. The proportion of patients with multiple histories of HCC treatment was higher in the DAA group.
At the end of treatment, 37% of patients in the interferon group and 92% of those in the DAA group achieved sustained virologic response.
HCC recurrence developed in 136 patients from the interferon group and 80 patients in the DAA group during a median observation period of 7.2 years. Tumor recurrence rates were 39% at 1 year and 61% at 2 years in the interferon group, and 39% at 1 year and 60% at 2 years for the DAA group. The rates did not differ significantly between the groups overall or by year.
The researchers performed a matching analysis of 61 patients from both the interferon and DAA groups that included the variables age, sex, platelet count and number of HCC treatments. The analysis showed no significant difference between treatment groups.
While the cumulative recurrence rate in patients with one history of HCC treatment was significantly lower than that in those with multiple histories of HCC treatment in both the interferon group (P = .004) and the DAA group (P = .01), the researchers observed no significant difference in HCC recurrence rates between the two groups.
Multivariate analysis showed that larger numbers of HCC treatment, shorter interval between the last HCC treatment and initiation of antiviral therapy, and higher alpha-fetoprotein levels as independent risk factors for HCC recurrence (P < .05).
“Previous studies have reported conflicting results on the early HCC recurrence rate after the initiation of DAA therapy,” Kinoshita and colleagues wrote. “These conflicting results occurred in part because of differences in tumor stage, HCC treatment modalities, interval between HCC treatment and DAA initiation, and indirect comparison of the DAA and control groups.” – by Talitha Bennett
Disclosure: Kinoshita reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.