Direct-acting antiviral use remains low, despite improved survival in HCV-related HCC

Key takeaways:

• Only about one in four patients with hepatitis C virus-related hepatocellular carcinoma receive direct-acting antiviral therapy.
• Approximately 75% of patients seen by a specialist were left untreated.

BOSTON — Direct-acting antiviral therapy for hepatitis C virus-related hepatocellular carcinoma significantly improves overall survival, but only one in four patients receive therapy, even with insurance, according to a researcher.

“In the past decade, oral direct-acting antivirals revolutionized HCV treatment due to their ability to essentially clear the virus from patients with a greater than 90% cure rate and being well-tolerated and safe in patients with advanced liver disease, such as HCC,” Leslie Yeeman Kam, MD, of Stanford University Medical Center, said in a related Q&A with AASLD. “Although prior studies have shown improved survival among DAA-treated HCV-related HCC patients, it is unclear if DAA is utilized effectively in the real world among this subset of patients.”

In a retrospective study presented at The Liver Meeting, Kam and colleagues aimed to determine the proportion of patients with HCV-related HCC who received DAA after 2014, as well as factors related to receiving treatment.

Using Optum’s Clinformatics Data Mart, researchers identified 3,922 adults with HCV-related HCC from 2015 to 2021, of whom 922 (23.5%) received DAA, and included in analysis those with at least 6 months of insurance coverage but without previous liver transplant, hepatitis B, D or HIV co-infection.

According to results, treatment rates were higher among patients with compensated and decompensated cirrhosis, as well as those who received care from a gastroenterologist or infectious disease specialist, with or without an oncologist. Patients treated with DAA also were younger (65.2 years vs. 66.4 years).

Further, multivariable logistic regression showed that younger age (aHR = 0.98; 95% CI, 0.97-0.99), being seen by a gastroenterologist or infectious disease specialist (aHR = 3.06; 95% CI, 2.13-4.51) and having cirrhosis (compensated: aHR = 1.6; 95% CI, 1.18-2.21 and decompensated: aHR = 1.45; 95% CI, 1.07-1.98) correlated with higher odds of receiving DAA treatment; however, sex or race/ethnicity did not.

Moreover, those who received DAA treatment had significantly higher 5-year survival compared with those who did not (47.2% vs. 35.2%).

“We found that DAA treatment significantly improved the overall survival of patients with HCV-HCC but only one in four ever received DAA therapy, despite having private insurance,” Kam said in the Q&A. “In addition, we found that over 50% of these patients had decompensated cirrhosis, suggesting that HCV-related HCC was found late in the course of disease. Although specialists had the highest rate of treatment, about 70% to 75% of patients seen by a specialist remained untreated.”

Kam continued, “There were also racial ethnic disparities in patient survival, whether patients received DAA or not, with Black patients having worse survival. As such, our study highlights that awareness of HCV remains low, as does the use of DAA treatment.”