medwireNews: Antiviral treatment is associated with improved long-term survival in individuals with virus-related hepatocellular carcinoma (HCC) who undergo curative hepatic resection, but the utilization rates are low, report the authors of a cohort study.
They found that antivirals were used at any time during study follow-up in 57% of patients with hepatitis B virus (HBV)-related HCC and 35% of those with hepatitis C virus (HCV)-related HCC.
And when initiated before or within 6 months of HCC diagnosis, antiviral therapy reduced the risk for all-cause death by a significant 40% among people with HBV-related HCC and by 82% among those with HCV-related HCC.
Similarly, the risk for cancer recurrence or death was significantly lower with antiviral use before or within 6 months of diagnosis versus no use in patients with HBV- and HCV-related HCC, with respective reductions of 36% and 38%.
Mindie Nguyen (Stanford University Medical Center, Palo Alto, California, USA) and co-investigators note that antiviral treatment “appeared to have a substantially larger impact” on overall survival (OS) than recurrence-free survival (RFS).
“These findings suggest that although antiviral treatment may reduce HCC recurrence, its major benefit may be in the prevention of hepatic decompensation and progressive liver disease,” they write in the Journal of Clinical Oncology.
The analysis included 1906 HCC participants of the Real-World Evidence from the Global Alliance for the Study of HCC (REAL-HCC) who underwent hepatic resection with curative intent at one of three centers in the USA or nine centers in Japan, Singapore, South Korea, and Taiwan between January 1992 and August 2022.
Participants were aged an average of 62 years and the majority were men (73.9%) and Asian (83.9%). Just over half (55.3%) had HBV-related HCC, while the remaining 44.7% had HCV-related HCC. In all, 47.0% received antiviral therapy during an average follow-up of 5 years.
Of note, the proportion of patients with HBV-related HCC who received antiviral therapy decreased over time, from 65% before 2010 to 60% during 2010–2015 and 47% after 2015. By contrast, the use of antiviral therapy rose among those with HCV-related HCC, from 24% before July 2015 to 74% since then.
In both groups, the 5- and 10-year OS rates were significantly higher among patients who did versus did not receive antivirals, at 78.2% versus 67.6%, and 61.3% versus 57.8%, respectively, for HBV-related HCC, and 91.6% versus 58.3%, and 81.7% versus 37.8%, respectively, for HCV-related HCC.
With regard to RFS, the rates were significantly higher with versus without antiviral therapy at 5 years in both the HBV- and HCV-related HCC groups, at 23.1% versus 21.0%, and 20.7% versus 17.8%, respectively, but the difference was significant at 10 years only among those with HCV-related HCC, at 10.0% versus 6.3%.
Nguyen et al highlight that “this study determined that the timing of antiviral initiation is critical,” explaining that although the risk for death and recurrence was “numerically reduced […] when antiviral treatment was initiated beyond 6 months from HCC diagnosis for both HBV- and HCV-related HCC, the association did not reach statistical significance.”
The researchers conclude that their findings “are concerning and call for greater awareness and multidisciplinary collaboration between surgeons, physicians, and health care policymakers to improve the utilization of lifesaving antiviral therapy for patients with HBV- and HCV-related HCC.”
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