534. Use of Direct-Acting Antivirals in Hepatitis C Virus-Infected Patients with Hepatocellular Carcinoma
Session: Poster Abstract Session: Hepatitis B and C in Varied Settings
Thursday, October 5, 2017
Room: Poster Hall CD
Background:

Hepatitis C virus (HCV)-infected patients (pts) with hepatocellular carcinoma (HCC) are at high risk for direct-acting antiviral (DAA) failure and controversy exists on the increased risk of HCC recurrence following DAAs. Herein, we evaluate the efficacy, safety and oncologic outcomes of HCV-infected pts with HCC treated with DAAs.

Methods:

This prospective observational study included consecutive pts seen at MD Anderson Cancer Center (01/2014-04/2017). Pts received 1 out of 5 different combinations. Efficacy was assessed by intention-to-treat (ITT) analysis based on sustained virological response 12 weeks after finishing DAAs (SVR12). Adverse events (AEs) and clinically significant drug-drug interactions (DDIs) were analyzed. AEs were graded according to the Division of AIDS Table (v 2.0). Cancer response was evaluated at the time of initiation and 6 months after finishing DAAs.

Results:

Twenty-seven pts were enrolled. The majority were men (85%), white (55%) with genotype 1 HCV (66%), Child-Pugh score A (85%), tumor stage 4 (41%) and eligible for potentially curative options (74%). The SVR12 (ITT) data are depicted in table. The most common AEs were headache (11%) and anemia (7%). Only one pt had grade 3 AE (renal failure) but grade 4 AEs or DDIs were not observed. Among pts with potentially curable HCC (n=20), the disease control rate was 35% (complete remission 10%, partial remission 25%) with recurrence rate of 5% (1 pt). None of the pts had de novo HCC within 6 months of DAAs. All 7 pts with unresectable HCC had stable disease within 6 months of DAAs.

Conclusion:

DAAs appear to be safe but of suboptimal efficacy in HCV-infected pts with HCC. More studies are needed to identify the subset of pts who will benefit from DAAs.

Table. SVR12 rates

Variable

SVR12 (ITT)

Overall

18 (66)

Treatment regimen

Sofosbuvir+ Ribavirin

2/3 (66)

Sofosbuvir+ Simeprevir

2/3 (66)

Ledipasvir/Sofosbuvir

10/16 (63)

Sofosbuvir/Velpatasvir

3/4 (75)

Paritaprevir/Ritonavir/Ombitasvir/Dasabuvir

1/1 (100)

Genotype

1

12/18 (66)

1a

10/15 (66)

1b

1/2 (50)

2

3/4 (75)

3

0/2 (0)

Other*

3/3 (100)

Type of HCC

Potentially curable

14/20 (70)

Unresectable

4/7 (57)

*Other genotypes included genotype 6 (1) and mixed genotypes (2).

Minas Economides, M.D., University of Texas Health Science, Houston, TX, Jeff Hosry, M.D., Infectious Diseases, The University of Texas Health Science at Houston, Houston, TX, Georgios Angelidakis, M.D., Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, Ahmed Kaseb, MD, Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX and Harrys Torres, M.D., Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX

Disclosures:

M. Economides, None

J. Hosry, None

G. Angelidakis, None

A. Kaseb, None

H. Torres, Gilead Sciences: Consultant and Grant Investigator , Consulting fee , Grant recipient and Research support
Merck & Co: Consultant and Grant Investigator , Consulting fee and Grant recipient
Janssen Pharmaceuticals, Inc: Consultant , Consulting fee
Dynavax Technologies: Consultant , Consulting fee

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