Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Faculty of Internal Medicine and Hepatitis Research Center, College of Medicine, and Center for Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
Clin Mol Hepatol. 2019 Jun;25(2):168-171. doi: 10.3350/cmh.2018.1014. Epub 2019 Feb 11.
During the clinical trial development of directly acting antivirals (DAAs), evidence regarding the treatment efficacy in chronic hepatitis C patients with hepatocellular carcinoma (HCC) was scarce because these patients have always been excluded. Apart from the clinical trials, more HCC patients are currently being treated in daily practice, given that these treatments are highly effective and involve well-tolerated regimens. Large scale, real-world studies have demonstrated potentially suboptimal antiviral treatment efficacy in HCC patients who received DAAs. It is postulated that the impairment of the bioavailability of DAAs may account for the inferior treatment response. However, the results could not be generalized across all studies. The differing results were attributed to diverse patient characteristics, suboptimal regimens or imprecise definitions of active cancer statuses at the time of treatment initiation. Additional large-scale studies that utilize the treatment of choice in clearly defined HCC patients with different disease severities are warranted to clarify the issue.
在直接作用抗病毒药物 (DAAs) 的临床试验开发过程中，由于这些患者一直被排除在外，因此关于慢性丙型肝炎患者合并肝细胞癌 (HCC) 的治疗效果的证据很少。除了临床试验外，目前在日常实践中治疗的 HCC 患者更多，因为这些治疗方法非常有效，且涉及耐受良好的方案。大规模的真实世界研究表明，接受 DAA 治疗的 HCC 患者的抗病毒治疗效果可能不理想。据推测，DAA 的生物利用度受损可能是导致治疗反应不佳的原因。然而，这些结果并不能在所有研究中推广。结果的差异归因于不同的患者特征、不优化的方案或在开始治疗时对活跃癌症状态的不精确定义。需要进行更多的大规模研究，使用不同疾病严重程度的明确定义的 HCC 患者的治疗选择，以澄清这一问题。
