Salvage therapy in cancer patients with hepatitis C without sustained virologic response after direct-acting antivirals-A prospective study.
cancer
direct‐acting antivirals
hepatitis C virus
salvage therapy
Journal
JGH open : an open access journal of gastroenterology and hepatology
ISSN: 2397-9070
Titre abrégé: JGH Open
Pays: Australia
ID NLM: 101730833
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
01
08
2019
revised:
19
11
2019
accepted:
01
12
2019
entrez:
10
6
2020
pubmed:
10
6
2020
medline:
10
6
2020
Statut:
epublish
Résumé
No information exists regarding direct-acting antivirals (DAAs) salvage therapy for Hepatitis C (HCV)-infected patients with any type of cancer. We prospectively evaluated the safety and efficacy (SVR12) of salvage therapy in these patients. Patients who failed initial DAAs (01/2015-01/2018) were analyzed. Resistance-associated substitutions to NS5A and NS3 were investigated by population sequencing. Of 164 patients enrolled, 16 (10%) experienced treatment failure. Of these, 11 patients received salvage therapy. The majority (91%) were men; 55% had genotype 1a, 45% had cirrhosis, and 45% had hepatocellular carcinoma. Four patients failed the first salvage therapy, and two of them required a second salvage therapy. Overall, 9 of 11 (82%) patients achieved SVR12. All four patients treated with sofosbuvir/velpatasvir/voxilaprevir (+/- ribavirin) achieved SVR12. The presence of resistance-associated substitutions did not impact response. Seven patients developed grade 1/2 adverse events. No patient had grade 3/4 adverse events. No patient required interruption of DAA therapy because of clinical or laboratory abnormalities. This is the first prospective study in HCV-infected cancer patients failing DAAs. The efficacy of salvage therapy in this group appears to be lower than previously reported in non-cancer patients, but better response rates are observed with newer regimens. Salvage therapy is associated with minimal toxicity.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
No information exists regarding direct-acting antivirals (DAAs) salvage therapy for Hepatitis C (HCV)-infected patients with any type of cancer. We prospectively evaluated the safety and efficacy (SVR12) of salvage therapy in these patients.
METHODS
METHODS
Patients who failed initial DAAs (01/2015-01/2018) were analyzed. Resistance-associated substitutions to NS5A and NS3 were investigated by population sequencing.
RESULTS
RESULTS
Of 164 patients enrolled, 16 (10%) experienced treatment failure. Of these, 11 patients received salvage therapy. The majority (91%) were men; 55% had genotype 1a, 45% had cirrhosis, and 45% had hepatocellular carcinoma. Four patients failed the first salvage therapy, and two of them required a second salvage therapy. Overall, 9 of 11 (82%) patients achieved SVR12. All four patients treated with sofosbuvir/velpatasvir/voxilaprevir (+/- ribavirin) achieved SVR12. The presence of resistance-associated substitutions did not impact response. Seven patients developed grade 1/2 adverse events. No patient had grade 3/4 adverse events. No patient required interruption of DAA therapy because of clinical or laboratory abnormalities.
CONCLUSIONS
CONCLUSIONS
This is the first prospective study in HCV-infected cancer patients failing DAAs. The efficacy of salvage therapy in this group appears to be lower than previously reported in non-cancer patients, but better response rates are observed with newer regimens. Salvage therapy is associated with minimal toxicity.
Identifiants
pubmed: 32514467
doi: 10.1002/jgh3.12294
pii: JGH312294
pmc: PMC7273696
doi:
Types de publication
Journal Article
Langues
eng
Pagination
541-544Informations de copyright
© 2019 The Authors. JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
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