Predictors of Sustained Virological Response in Cancer Survivors with Hepatitis C Virus Infection Receiving Antiviral Therapy
Methods: Records of HCV-infected pts with history of any type of cancer seen at MD Anderson Cancer Center from 2008-2011 were reviewed retrospectively. Cancer survivors (those with cancer in remission for at least 6 months) with HCV treated with AVT were further evaluated. Baseline characteristics of pts who achieved SVR were compared to those who did not achieve SVR. Categorical variables were compared using Chi-square test or Fisher’s exact test. Continuous variables were compared using Wilcoxon rank-sum test. Logistic regression modeling was used to determine predictors of SVR.
Results: Ninety-eight HCV-infected cancer survivors received AVT during the study period. The most common previous cancer was non-Hodgkin’s lymphoma (19%). Among the 78 pts with known treatment outcome, 27 (35 %) achieved SVR. AVT analyzed consisted of either a combination of interferon (IFN) and ribavirin (85%) or standard IFN monotherapy (15%). When compared to those who had SVR, more pts who failed AVT were males (44% vs 65%; P = 0.09), blacks (4% vs 29%; P = 0.007), had more genotype 1 infection (6% vs 69%; P < 0.001), higher baseline ALT (mean IU/L, 43 vs 71; P = 0.009), higher baseline AST (mean IU/L, 46 vs 77; P = 0.006), more leukopenia (total WBC count < 4,000 cells/µL) (4% vs 25%; P = 0.05) and neutropenia (absolute neutrophil count < 1,500 cells/µL)(0% vs 16%; P = 0.09). There was no statistically significant difference between those who achieved SVR and those who failed AVT with respect to type of previous cancer, baseline HCV RNA levels, CD4 count, body mass index, hepatitis B core antibody positivity, and cirrhosis. Only few pts were tested for IL28B polymorphism. After exact logistic regression analyses, those without genotype 1 infection (OR, 7.2; 95% CI 2.2-55.6; P < 0.001) had higher odds of achieving SVR.
Conclusion: AVT is feasible in cancer survivors, with genotype 1 infection being a major predictor of antiviral failure. More efficacious AVTs are needed in this emerging special population of HCV-infected pts.
H. A. Torres, None