Antivirals underutilized after curative resection of HBV- or HCV-related HCC

Antiviral therapy is associated with substantial improvements in long-term overall survival (OS) but severely underutilized after curative hepatic resection in patients with hepatitis B virus (HBV)– or hepatitis C virus (HCV)–related hepatocellular carcinoma (HCC), a real-world study involving predominantly Asian patients has shown.

The study, which investigated antiviral therapy utilization and its impact on long-term outcomes in HBV- or HCV-related HCC, included 1,906 patients (mean age, 62.1 years; male, 73.9 percent; Asian, 83.9 percent; HBV-related HCC, n=1,054; HCV-related HCC, n=852) who underwent curative hepatic resection between January 1992 and August 2022 at 12 international sites, including three centres in the US and nine centres in Asia (Japan, Taiwan, South Korea, and Singapore). [J Clin Oncol 2024;doi:10.1200/JCO.23.00757]

Over a mean follow-up duration of 5 years, 47 percent of patients in the total cohort received antiviral therapy. The overall antiviral utilization rate was 57 percent in patients with HBV-related HCC and 35 percent in patients with HCV-related HCC.

In the HBV cohort, antiviral utilization decreased over time, from 64.5 percent before 2010 to 59.7 percent in 2010–2015 and 47 percent since 2015 (p<0.0001). Multivariable analysis showed that presence of cirrhosis (adjusted hazard ratio [aHR], 0.80; 95 percent confidence interval [CI], 0.66–0.97; p=0.02) and HCC diagnosis after 2015 (aHR, 0.61; 95 percent CI, 0.48–0.77; p<0.0001) were independently associated with lower likelihood of antiviral utilization.

In the HCV cohort, antiviral utilization substantially increased over time, from 24 percent before July 2015 to 74.1 percent since July 2015. According to the researchers, this increase is likely due to the introduction of well-tolerated and efficacious direct-acting antiviral therapy in 2014. In multivariable analysis, recent HCC diagnosis (since July 2015) was the only significant independent predictor of antiviral utilization (aHR, 3.96; 95 percent CI, 1.67–9.40; p=0.002).

“Antiviral treatment was associated with substantial improvements in OS for both HBV- and HCV-related HCC, especially when initiated before or within 6 months from HCC diagnosis,” the researchers pointed out.

OS rates at 5 years and 10 years were 78.19 percent vs 67.64 percent and 61.27 percent vs 57.78 percent (p=0.0008), respectively, for patients treated vs untreated with antivirals in the HBV cohort. In multivariable analysis, antiviral therapy was associated with better OS when initiated before or within 6 months of HCC diagnosis (aHR, 0.60; 95 percent CI, 0.43–0.83; p=0.002).

In the HCV cohort, antiviral therapy was associated with even larger improvements in OS. Five-year OS rates were 91.55 percent vs 58.27 percent and 10-year OS rates were 81.67 percent vs 37.76 percent (p<0.0001) for patients treated vs untreated with antivirals. Multivariable analysis showed an 82 percent reduction in mortality risk when antiviral therapy was initiated before or within 6 months of HCC diagnosis (aHR, 0.18; 95 percent CI, 0.11–0.31; p<0.0001), and a 77 percent reduction in mortality risk that did not reach statistical significance when antiviral initiation was delayed to >6 months after HCC diagnosis (aHR, 0.23; 95 percent CI, 0.053–1.03; p=0.055).

Despite the association with long-term improvements in OS, the finding that antiviral therapy was “severely underutilized” in patients with HBV- or HCV-related HCC after curative resection was concerning, the researchers noted.

“These findings … call for greater awareness and multidisciplinary collaboration between surgeons, physicians, and health care policymakers to improve utilization of life-saving antiviral therapy for patients with HBV- and HCV-related HCC,” they suggested.