Of patients with hepatocellular carcinoma (HCC) and hepatitis C virus, about 75% can achieve virologic cure with direct-acting antiviral (DAA) drugs. In addition, more than 90% of HCC patients who have had a liver transplant can be cured of their HCV infection, according to a new study.
Treatment of HCV in patients with HCC was uncommon before the advent of DAA medications. Moreover, the real-world effectiveness of DAA use in this population has remained unclear. Researchers at the University of Washington, in Seattle, set out to study rates of sustained virologic response (SVR) for DAAs in U.S. veterans with a history of HCC (J Hepatol 2017 Mar 3. [Epub ahead of print]).
“The timing of hepatitis C virus treatment in patients with hepatocellular carcinoma is influenced by a lot of different factors—for example, the presence of cirrhosis, the status of the cancer, whether a patient is a liver transplant candidate,” said Lauren Beste, MD, of Veterans Affairs Puget Sound Health Care System and the study’s lead author. “The HCC population is one of the few groups left where there is truly uncertainty about when to offer hepatitis C treatment.”
Sorafenib improved OS among patients with hepatocellular carcinoma who were hepatitis C positive but hepatitis B negative, suggesting that the beneficial effects of sorafenib may be based on hepatitis status, according to results of a meta-analysis.
“Irrespective of the mechanism, our data suggest that in future trials in HCC, particularly where sorafenib is the control arm, there should be stratification according to etiology,” Richard Jackson, BSc, MSc, from the Liverpool Cancer Trials Unit of University of Liverpool in United Kingdom, and colleagues wrote. “Etiological differences have already been considered as factors in the interpretation of clinical trials.”
The analysis included 3,256 patients with HCC treated in three randomized phase 3 clinical trials that compared sorafenib (Nexavar, Bayer) with brivanib (BMS-540215, Bristol-Myers Squibb; n = 1,155), sunitinib (Sutent, Pfizer; n = 1,070) or linifanib (ABT-869, Abbott; n = 1,031).
Liver cancer is one of the most common types of cancer worldwide, resulting in 800,000 lives lost each year. What many people don’t know is that a staggering 80% of deaths are caused by viral hepatitis, a disease that has preventative vaccines (hepatitis B) and a curative treatment (hepatitis C), meaning that over 600,000 liver cancer deaths each year are avoidable.
If the majority of these deaths are entirely preventable, why does liver cancer continue to claim the lives of so many? And how do we begin to count that in terms of children who have lost a parent, people who have lost a friend, societies that have lost a great mind? The answer is simple; 95% of people living with viral hepatitis are unaware of this, and of those who do know their status, less than 1% have access to life-saving medical interventions.
Last year, at the 69th World Health Assembly, 194 countries adopted the World Health Organization’s first-ever Global Health Sector Strategy for viral hepatitis, which presents a clear commitment to eliminate hepatitis B and C by 2030. Combatting these cancer-causing viruses by 2030 is also a target of the Sustainable Development Goals. If these commitments are upheld by governments, we can greatly reduce the number of cancer deaths globally.