The Medscape article, presented by Leslie Yeeman Kam, MD, from Stanford University Medical Center, highlights a significant gap in the treatment of liver cancer related to hepatitis C viral infection (HCV). The retrospective study revealed that fewer than one in four patients with HCV-related hepatocellular carcinoma (HCC) received all-oral, noninterferon, direct-acting antiviral (DAA) agents, despite these agents’ proven survival benefits. The study was discussed at The Liver Meeting 2023 of the American Association for the Study of Liver Diseases (AASLD).
Patients with HCV-related HCC who were seen by gastroenterologists and infectious disease specialists, with or without an oncologist’s consultation, were more likely to receive DAAs. Those with compensated or decompensated cirrhosis were also more likely to be treated with DAAs. The low uptake of DAAs in this population might be due to a lack of awareness of the drugs’ availability and benefits or a lack of resources for testing and treatment.
The study, which used data from Optum’s Clinformatics Data Mart database, included 3,922 adults with HCV-related HCC treated between January 2015 and March 2021. Only 922 (23.5%) of these patients were treated with DAAs. The 5-year overall survival rate was significantly better for patients who received DAAs (47.2%) compared to those who did not (35.2%).
Early concerns about the safety of noninterferon DAAs in patients with HCV-related HCC may have contributed to the slow acceptance of these agents. There were initial fears that DAAs might exacerbate HCC, but with more experience, clinicians realized the benefits of treating patients with HCC and decompensated cirrhosis.