Advances in the era of direct-acting antivirals for hepatitis C in patients with unresectable hepatocellular carcinoma.

BACKGROUND In patients with unresectable hepatocellular carcinoma (HCC), the advances in direct-acting antiviral (DAA) therapy for chronic hepatitis C remain unclear. We aimed to investigate the characteristics of DAA therapy, when compared to interferon (IFN) therapy. METHODS In this hospital-based study, all HCC patients in Barcelona Clinic Liver Cancer (BCLC) stage B or C, who received pegylated IFN or DAA, were retrospectively screened from 2009 to 2020. Patients without viremia, without HCC, or with HCC in BCLC stage 0, A, or D prior to antiviral therapy, were excluded. Rates of, and odds ratio (OR) for sustained virological response (SVR) achievement were analyzed. RESULTS Nineteen and 78 patients were recruited into the IFN and DAA groups, respectively. The median age was significantly older in the DAA group (DAA vs. IFN: 69.5 [25%-75% IQR: 62.8-77.3] vs. 64.0 [25%-75% IQR: 61.0-68.0]; p< 0.05). The SVR rates were higher in the DAA group as per protocol (DAA vs. IFN: 94.5% vs. 76.5%; p< 0.05) and in BCLC stage B (DAA vs. IFN: 95.2% vs. 76.5%; p< 0.05). All patients in BCLC stage C received DAA therapy, with the SVR rate being 90.9%. In multivariable regression analysis, the 4-week virological response (OR 5.6, 95% CI: 1.3-25.4) and HCC within the up-to-7 criteria (OR 3.7, 95% CI: 1.1-12.9) were independent factors associated with SVR (all p< 0.05). CONCLUSIONS Compared to IFN therapy, more elderly patients with unresectable HCCs were able to receive DAA therapy, while achieving a significantly higher SVR rate.