Adjuvant PegIFN/RBV Ups Survival in HCV/HCC Patients Receiving TACE
BOSTON, MA—In patients with chronic hepatitis C virus (HCV) infection and intermediate stage hepatocellular carcinoma (HCC) who receive transarterial chemoembolization (TACE), the SVR achieved with pegylated-interferon (pegIFN/ribavirin (RBV) treatment markedly improved survival and reduced tumor recurrence, a study presented at The Liver Meeting 2016® concluded.
“Clearance of viremia, rather than interferon itself, improved diagnosis” in these patients, noted Wei Teng, of the department of gastroenterology and hepatology at Chang Gung Memorial Hospital, Linkou Branch, Taiwan.
From 2010–2013, the study enrolled 274 patients with chronic HCV newly diagnosed with HCC and receiving TACE treatment at their hospital.
The investigators performed propensity score matching for age and Barcelona Clinic Liver Cancer (BCLC) stage score with a ratio of 1:2 for patients with and without peg-IFN/RBV treatment.
After matching age and BCLC stage, 126 patients were analyzed, 42 who were treated and 84, untreated. At total of 23 (54.8%) had achieved sustained virologic response (SVR).
The two-year cumulative overall survival rate was 85% among patients with SVR; 29% for those who did not attain SVR; and 25% for untreated patients (P=0.001). The tumor-free survival rate was 74%, 22%, and 15%, respectively (P=0.038).
Median overall survival was 57.7 months (range 52.0–63.5) in the SVR group; 43.0 months (range 21.1–65.0) in the non-SVR group, and 36.3 months (range 27.4–45.1) in the untreated group (P<0.001).
By logistic regression analysis, SVR (adjusted odds ratio [OR] 0.062 [95% CI: 0.007–0.512], P=0.008), absent CTP scores increase after first TACE (adjusted OR 0.220 [95% CI: 0.067–0.727], P=0.013), and good response at first TACE (adjusted OR 0.340 [95% CI: 0.122–0.954], P=0.040) were independent protective factors related to mortality, the investigators noted.
Protective factors related to tumor recurrence were SVR (OR 0.133 [95% CI: 0.024–0.729], P=0.020), aspartate aminotransferase to alanine aminotransferase ratio <1.5 (OR 0.217 [95% CI: 0.041–0.933], P=0.040), and absence of diabetes mellitus (OR 0.216 [95% CI: 0.042–0.918], P=0.048).