A recent study in UK has shown a significant proportion of patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) initiating direct-acting antiviral (DAA) therapy, resulting in improvements in sustained virological response (SVR) rates.
DAA therapies and SVR yield overall survival (OS) benefits in this cohort regardless of Barcelona Clinic Liver Cancer (BCLC) stage.
“[M]ore than two-thirds of patients with HCV-related HCC initiated DAA therapies leading to a higher rate of SVR,” said lead study author Dr Maria Guerra Veloz, King's College Hospital, Institute of Liver Studies, London, UK. “DAA therapies along with SVR are associated with improvement in OD independent of BCLC stage and so treatment should be started in eligible patients.”
Veloz and her team identified patients with HCV-related HCC using the National Hepatitis C registry in Greater London between 2015 and 2025. They cross-referenced patient data with their local multidisciplinary HCC team records and compared those who initiated DAA therapy with noninitiators.
Three hundred forty-three patients had complete records and were included in the analysis. Most of them were male (79 percent) with compensated cirrhosis (62.7 percent) and genotype 3 (45.5 percent). Of the patients, 270 (78.7 percent) initiated DAA therapies, with 239 (88.5 percent) having an outcome reported. Some 212 of the 239 patients (88.7 percent) achieved SVR. [EASL 2026, abstract OS-102]
Among patients who started DAA therapies, 64.4 percent had cancer stage distribution of BCLC 0/A, 16.7 percent B, 10 percent C, and 4.4 percent D. Among noninitiators, the corresponding distribution was 45.7 percent, 5.7 percent, 18.6 percent, and 30 percent (p<0.005). The majority in this cohort (80 percent) had untreated HCC at the time of DAA therapy initiation.
Survival benefit
Patients with HCV-related HCC treated with DAA therapy had a longer median OS (68 months, 95 percent confidence interval [CI], 48‒87) than noninitiators (15 months, 95 percent CI, 7‒23; log rank p<0.001). OS was also longer in those with BCLC stage 0/A who achieved SVR (128 months, 95 percent CI, 112‒144) than those with BCLC stage 0/A who did not receive DAAs (25 months, 95 percent CI, 12‒37).
Furthermore, the median OS among patients with BCLC stage B/C who achieved SVR was 35 months (95 percent CI, 26‒44), while that of those who did not initiate DAAs was 9 months (95 percent CI, 0‒19).
Multivariate analysis adjusted by sex, age, BCLC stage, and liver function revealed the following factors associated with increased mortality risk: noninitiation of DAA therapy (hazard ratio [HR], 7.0; p<0.001), non-SVR (HR, 2.3; p<0.001), BCLC stage C/D (HR, 1.43; p<0.001), and noncurative cancer treatment (HR, 1.95).
“Patients with HCV-related HCC have largely been excluded from European HCV National treatment registries and so the survival benefits in this cohort are unclear,” said Veloz and colleagues. “Since 2015, NHS England has approved DAA therapies for all viraemic patients, including those with HCC.”