Hepatitis Treatments Underutilized Among ‘Sickest’ With Liver Cancer

Antivirus treatments are underutilized for patients with liver cancer who also have hepatitis B or C, especially among patients who underwent curative surgery.

Utilization of antiviral treatments can play a crucial role in the survival outcomes of patients with either hepatitis B (HBV) or hepatitis C (HCV) viruses and hepatocellular carcinoma (HCC; most common type of liver cancer). However, researchers have found that antiviral therapy is “severely underutilized” among patients with HBV- or HCV-related HCC who undergo curative resection (surgery).

In an international study of 1,906 patients — 1,054 with HBV-related HCC and 852 with HCV-related HCC — who underwent curative resection (average age of 62.1, 74% of whom were male and 84% of whom were Asian), 47% received antiviral therapy during a mean follow-up of five years, according to findings recently published in the Journal of Clinical Oncology.

Overall utilization of antiviral treatments was 57% among patients with HBV-related HCC and was observed to decline over time — it was 65% before 2010, 60% from 2010 to 2015 and 47% after 2015.

Overall antiviral treatment utilization for HCV-related HCC was 35% but, in contrast to patients with HBV-related HCC, climbed over time, starting at 24% before 2015 and rising to 74% from 2015 and beyond, according to study findings.

For both subgroups of patients, 10-year rates of overall survival (OS; the time a patient lives following treatment regardless of disease status) were lower for untreated patients versus those who received antiviral treatment — 58% versus 61% for patients with HBV and 38% versus 82% for those with HCV, with initiation of antiviral therapy within six months of receiving a diagnosis of HCC associated with lower mortality in both patient subgroups.

“These are very highly selected patients who know how to get to a liver center and get this care, and even among this group, the treatment rate is far from 100%. So, our main goal for this (study) is to show how under-utilized this is, even in a highly specialized center, even in well-selected patients, to just really bring the awareness for both physicians and patients alike,” said study lead author Dr. Mindie H. Nguyen of the division of gastroenterology and hepatology at Stanford University Medical Center and the department of epidemiology and population health at Stanford University in Palo Alto, California.

Long-term infections with HBV and HCV are linked to cases of HCC because the viruses often lead to liver damage if not diagnosed and treated, as explained by the American Liver Foundation. Nguyen said that in a nearly 30-year career, she has never seen a patient with liver cancer who did not also have chronic, underlying liver disease. She is hopeful that with her team’s findings, patients will be more likely to adhere to antiviral treatments.

“Our job is to try to tell patients that you take medication forever for diabetes and hypertension, so you should think of this as the same, as a chronic disease for the case of chronic HBV infection,” she said. “And I focused on HCC patients, because these are the patients who need it the most, these are the sickest of the sick.” For HCV, Nguyen noted, patients can be cured after a treatment course of only 12 weeks with currently approved oral treatment.

“What I’m hoping the patients and providers take away from this is that if their patients have liver cancer, because of either hepatitis B or hepatitis C, there are very well-tolerated and effective medications to either cure the patient, like for hepatitis C, or, for hepatitis B we don’t have curative treatment but (we do have) very good suppressive medication that they should really consider for their patients,” Nguyen said. “In my opinion, people with HCC and hepatitis B or C, if they have detectable virus in their blood — and that can easily be confirmed by a PCR test that any national reference lab like LabCorp or Quest, anybody can do — if it’s positive at any level at all, the patients should be considered and offered the medications. However, the decision to treat patients with very limited life expectancy and very advanced disease should be individualized as it is unclear if antiviral treatment is still beneficial in this setting.”

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