Sorafenib-treated hepatocellular carcinoma with or without prior direct-acting antiviral therapy for hepatitis C: outcomes and survival

Abstract Background Hepatitis C virus (HCV) has been linked to lower tumor growth rates, higher sorafenib efficacy, and greater survival of patients treated for hepatocellular carcinoma (HCC). In real-world settings, we tried to elucidate the effectiveness of sorafenib therapy for patients with HCV-related HCC with previous direct-acting antiviral (DAAs) therapy or not. Methods This retrospective multicenter work recruited participants with sorafenib-treated HCC with and without previous DAAs therapy from November 2016 to April 2023 and followed up until death or the study end in April 2024. We compared the patients’ clinico-laboratory, imaging variables, and overall survival (OS). Results This work included 622 patients; 535 patients received DAAs before the development of HCC (group I), and 87 patients did not (group II). Group II patients showed higher rates of nausea, vomiting, and diarrhea than group I patients, while group I patients experienced higher rates of jaundice during sorafenib therapy. None of the patients achieved complete response (CR) after sorafenib. Patients previously treated with DAAs were less common to show partial response (PR) (12.9% versus 23%, respectively, P -value 0.011). The disease control rate (PR + CR + stable disease (SD)) was 45% in group I and 52.9% in group II. Group I had a considerably reduced median survival rate. The patients with SVR prior to HCC development had a median OS that was significantly lower than both non-responder patients (285.00 versus 629.00 days, respectively, P -value < 0.001) and patients without DAAs (285.00 versus 580.00 days, respectively, P -value < 0.001). Conclusion DAAs therapy before the onset of HCC might be linked to lower rates of response to sorafenib compared to DAAs-naïve patients. Furthermore, it might be connected to a decreased overall survival rate in patients treated with sorafenib.