To treat or not to treat – Successful hepatitis C virus eradication in a patient with advanced hepatocellular carcinoma and complete response to sorafenib

 

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Abstract

Background and aims Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. Infection with the hepatitis C virus (HCV) is one of the most frequent underlying diseases leading to HCC development. Sorafenib is the standard of care for HCC patients not amenable to local treatment, resection, or liver transplantation. Although overall survival can be increased, objective response rates in patients treated with sorafenib are low. In HCC patients who underwent resection or ablation, HCV eradication with interferon-based regimens reduces the risk of recurrence. However, it is not known and under strong debate if patients with HCC should be treated with interferon-free regimens. Furthermore, it is not known if patients with advanced HCC at the time of diagnosis should be treated with antiviral therapy.

Methods A patient with histologically confirmed advanced-stage HCC due to HCV-related cirrhosis was treated with sorafenib according to current guideline recommendations. Furthermore, he received subsequent treatment with direct antiviral agents (DAAs).

Results The patient achieved a complete response after sorafenib treatment was initiated. Sorafenib treatment was terminated 1 year after complete response. As no recurrence of HCC was evident after treatment cessation, antiviral treatment was initiated with paritaprevir/ritonavir, ombitasvir, dasabuvir, and dose-reduced ribavirin because of chronic kidney disease. The patient achieved a sustained viral response.

Conclusions Complete response to sorafenib treatment is scarce. Antiviral treatment should be considered in such patients as well as in patients with HCC who underwent resection or ablation.

Zusammenfassung

Hintergrund Das Hepatozelluläre Karzinom (HCC) zählt zu den häufigsten krebsbedingten Todesursachen weltweit. Die chronische Infektion mit dem Hepatitis-C-Virus (HCV) gehört zu den häufigen zugrunde liegenden Lebererkrankungen, die zur Entstehung eines HCC führen. Sorafenib ist die Standardtherapie für HCC-Patienten, die nicht operiert oder mittels lokal-ablativen Verfahren behandelt werden können. Sorafenib verlängert das Gesamtüberleben von HCC-Patienten. Allerdings sind die objektiven Ansprechraten der Tumore auf die Therapie eher niedrig.

Eine Interferon-haltige antivirale Therapie reduziert das Risiko für das Auftreten eines HCC-Rezidivs. Ob auch eine Interferon-freie antivirale Therapie das Rezidivrisiko senkt, wird derzeit kontrovers diskutiert. Zudem ist es bislang noch nicht geklärt, ob auch Patienten mit fortgeschrittenem HCC eine antivirale Therapie erhalten sollten.

Methoden Ein 56-jähriger Patient mit fortgeschrittenem HCC auf dem Boden einer HCV-assoziierten Leberzirrhose wurde leitlinienkonform mit Sorafenib behandelt. Bei sehr gutem Ansprechen erhielt er daraufhin eine Interferon-freie antivirale Therapie.

Ergebnisse Der Patient erzielte eine komplette Remission des HCCs unter Sorafenib-Therapie. Die Therapie wurde ein Jahr nach Erreichen der Remission beendet. Hierauf wurde eine antivirale Therapie mit Paritaprevir/Ritonavir, Ombitasvir, Dasabuvir und Dosis-reduziertem Ribavirin bei chronischer Niereninsuffizienz durchgeführt. Es fand sich ein dauerhaftes virologisches Ansprechen.

Diskussion Eine komplette Remission unter Sorafenib-Therapie ist selten. Bei entsprechenden ausgewählten Patienten und bei Patienten bei denen entweder ein HCC reseziert wurde oder der Tumor komplett abladiert wurde, sollte eine antivirale Therapie erwogen werden.

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