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Non-Genotype 1 HCV Predicts Sustained Virologic Response in Cancer Survivors
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AASLD/EASL NY Conference/2014: Most patients with HCV-associated lymphoma present with mild liver disease at cancer diagnosis: A call to revise indications for HCV treatment - (09/26/14)
IDWeek 2014, October 8-12, 2014, Philadelphia
Mark Mascolini
Infection with an HCV genotype other than type 1 independently raised the odds of achieving sustained virologic response after 24 weeks (SVR24), according to a retrospective review of cancer survivors at Houston's MD Anderson Cancer Center [1]. But the analysis did not include people taking direct-acting antivirals (DAAs) for HCV, so the impact of these new agents in people with cancer cannot be determined from this analysis.
When interferon and ribavirin were the only drugs available for HCV infection, noted MD Anderson researchers who conducted this study, physicians were reluctant to treat HCV-infected cancer patients for HCV because interferon and ribavirin can worsen hematologic deficits common in cancer patients. To get a better understanding of response to interferon and ribavirin in HCV patients with cancer, the investigators conducted this retrospective analysis of HCV/cancer patients at MD Anderson Cancer Center.
The MD Anderson team reviewed medical records of HCV-positive people with any type of cancer who received HCV therapy from 2008 through 2011. They defined cancer survival as remission for more than 6 months since the last cancer treatment. The investigators compared baseline factors in people who did and did not achieve SVR24. They used logistic regression analysis to identify predictors of SVR among all variables significant at P < 0.2 in univariate analysis.
During the study period, 98 cancer survivors received HCV therapy. The most frequent cancer was non-Hodgkin lymphoma, in 19%. Among 78 people with known outcomes, 27 (35%) achieved SVR and 51 did not. Most study participants (85%) received interferon/ribavirin, while 15% received only interferon. Several factors distinguished people who achieved SVR from those who did not:
SVR versus no SVR in 78 cancer survivors:
Men: 44% vs 65%, P = 0.09
Blacks: 4% vs 29%, P = 0.007
Genotype 1 HCV: 6% vs 69%, P < 0.001
Baseline ALT: mean IU/L 43 vs 71, P = 0.009
Baseline AST: mean IU/L 47 vs 78, P = 0.006
Leukopenia: total WBC below 4000 cells/uL: 4% vs 25%, P = 0.05
Neutropenia: absolute neutrophil count below 1500 cells/uL: 0% vs 16%, P = 0.09
Factors that did not differ significantly by SVR response were age, cancer type, hepatitis B core antibody positivity, use of hematopoietic stem cell transplantation, baseline cirrhosis, baseline HCV RNA above 600,000 IU/mL, and baseline body mass index.
Only 1 of 27 people (4%) with genotype 1 HCV attained SVR. More than half with genotype 2, 3, or 6 attained SVR. Logistic regression analysis singled out only one factor independently associated with achieving SVR: People without genotype 1 HCV had 7 times higher odds of SVR (adjusted odds ratio 7.2, 95% confidence interval 2.2 to 55.6, P < 0.001).
The researchers concluded that HCV therapy is feasible in cancer survivors, adding that "more efficacious and better tolerated antiviral therapies including direct-acting antiviral agents could improve SVR in this 'special population' of HCV-infected patients."
Reference
1. Mahale P, Kyvernitakis A, Torres H. Predictors of sustained virological response in cancer survivors with hepatitis C virus infection receiving antiviral therapy. IDWeek 2014. October 8-12, 2014, Philadelphia. Abstract 1180.
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