Keywords
1. Hepatitis C treatment
2. Direct-acting antivirals
3. Hepatocellular carcinoma
4. Sustained virological response
5. Antiviral treatment efficacy
In a groundbreaking prospective cohort study, researchers from Taiwan have delivered strong evidence supporting the effectiveness of direct-acting antivirals (DAAs) in treating patients with chronic hepatitis C (HCV), irrespective of the presence of hepatocellular carcinoma (HCC). The study’s lead author, Chung-Feng Huang, along with his colleagues at the Kaohsiung Medical University Hospital and associated institutions, meticulously gathered data from 713 Taiwanese patients who underwent DAA therapy. Their findings counter ongoing debates and signify a pivotal moment in the treatment of HCV patients with concurrent HCC, instilling hope for equal therapeutic outcomes.
Background
According to the World Health Organization, approximately 71 million individuals globally are afflicted with chronic HCV infection, which if untreated, can result in cirrhosis or HCC. Historically, the attainment of a sustained virological response (SVR) – an undetectable HCV RNA level 12 weeks post-treatment – had been challenging, particularly in patients with HCC, due to lower efficacy and safety concerns of interferon-based regimens. As DAAs revolutionized hepatitis C treatment with their high efficacy and tolerability, queries about their performance in HCC patients persisted.
The Study
Spanning a medical center and two regional hospitals, the research inquired whether DAAs provided equivalent treatment efficacy in patients with HCV, segmented by their HCC status. The non-HCC group, curative HCC group (those with a history of HCC but considered cured), and the active HCC group formed the cohorts of the study. The DAAs’ effectiveness was gauged primarily on the SVR12 rates, and safety was assessed considering adverse events, treatment discontinuation, and mortality.
Results
Defying doubts, the overall SVR12 rate was an impressive 96.9%. SVR12 was comparably high in patients with HCC (95.5%) and those without (97.2%), with a p-value of 0.37, demonstrating no statistically significant difference. Within the HCC cohort, results showed a somewhat albeit not statistically significant lower SVR rate in patients with viable HCC (92.1%) compared to those with curative HCC (97.3%). A higher proportion of severe adverse events and early treatment discontinuation were noted among patients with active HCC. Still, these did not significantly undermine the SVR12 achievement rates, holding out the efficacy of DAAs even in these high-risk profiles.
Implications
This study alone paves the way for a transformative approach in treating chronic HCV patients with coexistent HCC. It supports other findings that HCV eradication with DAAs may indeed lessen the risk of HCC development. By affirming the efficacy across different HCC statuses, it could lead to a standardized treatment protocol, potentially improving the prognosis for patients previously deemed challenging cases.
Perspectives and Limitations
Although the study presents robust data, it is not without limitations representative of the Taiwanese demographic. Consequently, wider application requires scrutinizing these findings alongside heterogeneous populations. Further longitudinal studies are recommended to understand the long-term impacts of DAAS in HCV patients with HCC.
DOI and References
The study, identifiable by the DOI 10.1136/bmjopen-2018-026703, enriches the repository of clinical evidence on DAAs’ prowess in managing chronic hepatitis C, with or without HCC. The researchers attributed the foundational knowledge of the study to several literature works, which include the following five key references:
Akinyemiju, T., Abera, S., Ahmed, M., et al. (2017). The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level: results from the global burden of disease study 2015. JAMA Oncol, 3, 1683–91. DOI: 10.1001/jamaoncol.2017.3055
European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol, 69, 182–236. DOI: 10.1016/j.jhep.2018.03.019
Polaris Observatory HCV Collaborators. (2017). Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol, 2, 161–76. DOI: 10.1016/S2468-1253(16)30181-9
Yu, M.L., Huang, C.F., Yeh, M.L., et al. (2017). Time-degenerative factors and the risk of hepatocellular carcinoma after antiviral therapy among hepatitis C virus patients: a model for prioritization of treatment. Clin Cancer Res, 23, 1690–7. DOI: 10.1158/1078-0432.CCR-16-0921
Ioannou, G.N., Green, P.K., Berry, K. (2017). HCV eradication induced by direct-acting antiviral agents reduces the risk of hepatocellular carcinoma. J Hepatol, DOI: 10.1016/j.jhep.2017.08.030
Concluding Remarks
As we assimilate these promising results into clinical practice, it remains crucial for healthcare providers to maintain vigilant follow-up care for patients with a history of HCC undergoing DAA therapy. The emerging perspective from this determined set of researchers facilitates a united direction—not only for the treatment of chronic hepatitis C but also its implications in oncologic spheres. With the continued expansion of medical knowledge and the firmament of evidence-based medicine, equitable treatment efficacy glimmers on the horizon for all HCV-infected individuals, heralding a new era in antiviral therapy.