543. Salvage Therapy in Cancer Patients With Hepatitis C Infection Failing Direct-Acting Antivirals – A Prospective Study
Session: Poster Abstract Session: Hepatitis B and C in Varied Settings
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • Salvage Therapy in Cancer Patients With HCV Infection Failing DAAs - A Prospective Study-Final.pdf (647.2 kB)
  • Background: Direct-acting antivirals (DAAs) are commonly used in Hepatitis C (HCV)-infected cancer patients. While treatment failure in these patients is rare, little information exists regarding antiviral salvage therapy. We evaluated the treatment outcomes of this patient population.

    Methods: Cancer patients who received initial DAAs (01/2014-06/2016) were analyzed for viral relapse, defined as reappearance of HCV RNA in serum after discontinuation of DAAs. We evaluated safety and efficacy of salvage. RAS (resistance-associated substitutions) to NS5A/B and NS3 were identified using commercially available assays (population sequencing).

    Results: Of 160 patients enrolled in a prospective observational study, 15 (15/160; 9%) experienced treatment failure. Of these, 7 received salvage therapy (7/15; 47%) (Table). The majority of patients were men (86%), cirrhotics (57%), and had solid tumors (71%). Ultimately 3/7 (43%) patients achieved sustained virologic response (SVR). Of the 4 patients who failed 1st salvage treatment, 3 (75%) had RASs prior to such therapy, 3 (75%) had HCC, and 1 (25%) underwent 2ndsalvage. None of the patients experienced grade 3/4 adverse events.

    Conclusion: HCV relapse after DAAs is rare in cancer patients, but the efficacy of salvage is suboptimal. More effective rescue therapies are needed.

    Table. Patient characteristics, DAA regimens, and Outcomes

    Gender

    Age

    Genotype

    Cirrhosis

    Malignancy

    IFN experienced

    DAA

    regimen failed

    Duration (weeks)

     NS3 RAS at failure

     NS5A/B RAS at failure

    1st salvage DAA

    Duration

    (weeks)

    Adverse Events

    Grade

    3 or 4

    Virologic

    outcome

    M

    56

    1a

    Yes

    Colon

    Yes

    SOF/IFN/RBV

    12

    No

    No

    SOF/LDV

    24

    No

    SVR24

    M

    87

    1b

    Yes

    HCC

    No

    SOF/SIM

    12

    No

    No

    SOF/LDV/RBV

    24

    No

    Relapse

    M

    65

    1a

    Yes

    DLBCL, HCC

    No

    SOF/LDV

    12

    No

    Q30R

    SOF/SIM/RBV

    24

    No

    Relapse

    F

    56

    3a

    No

    DLBCL

    Yes

    SOF/RBV

    24

    No

    No

    SOF/DCV/RBV

    24

    No

    SVR24

    M

    58

    1a

    No

    HCC

    No

    SOF/LDV

    12

    No

    Q30Q/H, Y93H

    SOF/SIM/RBV

    24

    No

    SVR24

    M

    63

    1a

    Yes

    HCC

    Yes

    SOF/LDV

    24

    No

    Q30R

    SOF/VEL/RBV

    24

    No

    Relapse

    M

    66

    1a

    No

    SCC

    No

    SOF/LD

    12

    Q80K, D168E

    M38A, Q30H

    ELB/GZV/RBV

    24

    No

    Relapse

    DCV, daclatasvir; DLBCL, diffuse large B-cell lymphoma; ELB, elbasvir; GZV, grazoprevir; HCC; hepatocellular carcinoma; LDV, ledipasvir; RBV, ribavirin; SCC, squamous cell carcinoma; SIM, simeprevir; SOF, sofosbuvir; SVR24, SVR at 24 weeks

    Haley Pritchard, MD, Department of Medicine Division of Infectious Disease, Baylor College of Medicine, Houston, TX, Deeksha Jandhyala, M.D., Division of Infectious Diseases, University of Texas Health Science Center at Houston, Houston, TX, Minas Platon Economides, MD, Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, Jeff Hosry, M.D., Infectious Diseases, The University of Texas Health Science at Houston, 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:

    H. Pritchard, None

    D. Jandhyala, None

    M. P. Economides, None

    J. Hosry, None

    H. Torres, None

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