George N. Ioannou, MD, associate professor, VA Puget Sound Health Care System, University of Washington School of Medicine, discusses the best treatment options for patients with hepatocellular carcinoma (HCC).

According to Ioannou, most patients with HCC receive some kind of locoregional therapy, such as chemoembolization and radiofrequency ablation. Then the physician can move on to treating the patient's hepatitis C.

When it comes to treating these patients with antiviral agents, the hope is that they will be successful, and that 2 things might happen: their underlying liver disease will not get any worse or might even get better with time, and that the resolution of the hepatitis C virus might reduce the chances of developing new liver cancers. Ioannou says future research is warranted in this area.

There are certain patients who should not be treated with antiviral agents, he says, as they are unlikely to see the same benefits. These include patients with very advanced liver cancer, untreatable liver cancer, or liver cancer that has been treated, but there is still residual disease. Most of the time, says Ioannou, oncologists consider antiviral treatment if the liver cancer has been successfully treated in the first place.

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George N. Ioannou, MD, associate professor, VA Puget Sound Health Care System, University of Washington School of Medicine, discusses the best treatment options for patients with hepatocellular carcinoma.

Dr. Ioannou on Treatment Options in Hepatocellular Carcinoma

George N. Ioannou, MD, associate professor, VA Puget Sound Health Care System, University of Washington School of Medicine, discusses a study evaluating the effectiveness of direct antiviral agents for hepatitis C virus patients with hepatocellular carcinoma (HCC).

The study aimed to understand the real-world effectiveness of antiviral agents

sofosbuvir (SOF), ledipasvir/sofosbuvir (LDV/ SOF) and paritaprevir/ritonavir/ombitasvir and dasabuvir (PrOD) by hepatitis C genotype and clinically relevant subgroup.

Using data from the Veterans Affairs healthcare system, 624 patients were evaluated regarding completion of treatments and sustained virologic response (SVR).

These results were both encouraging and interesting, says Ioannou.

Differences between SVR were seen between genotypes, with a SVR of 92.8 (95% CI 92.3-93.2) for genotype 1-infected patients with no significant difference between regimens; a SVR of 86.2% (95% CI 84.6-87.7) for genotype 2-infected patients treated with SOF and ribavirin; 74.8% (95% CI 72.2-77.3) for genotype 3-infected patients; and 89.6% (95% CI 82.8-93.9) for genotype 4-infected patients.

Just looking at genotype 1 patients, who had the highest success rates, the group that didn’t have liver cancer has an SVR was 94% and the SVR in the HCC group was 79%. This is a good rate for both groups, especially considering the outcomes for these patients before effective antiviral agents were available, says Ioannou. Among patients in this group that had HCC and then had a liver transplant, the success rate was almost as good as those who had never had liver cancer, at 94%.

This trend consisted across all the other genotypes, says Ioannou.

​George N. Ioannou, MD, associate professor, VA Puget Sound Health Care System, University of Washington School of Medicine, discusses a study evaluating the effectiveness of direct antiviral agents for hepatitis C virus patients with hepatocellular carcinoma (HCC).

George N. Ioannou, MD

Articles

Dr. Ioannou on Treatment Options in Hepatocellular Carcinoma

Dr. George N. Ioannou on the Efficacy of Antiviral Agents for Hepatitis C in HCC Patients