Abstract
Background Direct-acting antivirals (DAAs) are commonly used in Hepatitis C (HCV)-infected cancer patients. While treatment failure in these patients is rare, little information exists regarding antiviral salvage therapy. We evaluated the treatment outcomes of this patient population.Methods Cancer patients who received initial DAAs (01/2014-06/2016) were analyzed for viral relapse, defined as reappearance of HCV RNA in serum after discontinuation of DAAs. We evaluated safety and efficacy of salvage. RAS (resistance-associated substitutions) to NS5A/B and NS3 were identified using commercially available assays (population sequencing).ResultsOf 160 patients enrolled in a prospective observational study, 15 (15/160; 9%) experienced treatment failure. Of these, 7 received salvage therapy (7/15; 47%) (Table). The majority of patients were men (86%), cirrhotics (57%), and had solid tumors (71%). Ultimately 3/7 (43%) patients achieved sustained virologic response (SVR). Of the 4 patients who failed first salvage treatment, 3 (75%) had RASs prior to such therapy, 3 (75%) had HCC, and 1 (25%) underwent second salvage. None of the patients experienced grade 3/4 adverse events.Conclusion HCV relapse after DAAs is rare in cancer patients, but the efficacy of salvage is suboptimal. More effective rescue therapies are needed.Disclosures All authors: No reported disclosures.Table:Patient characteristics, DAA regimens, and outcomesGenderAgeGenotypeCirrhosisMalignancyIFN experiencedDAA regimen failedDuration (weeks) NS3 RAS at failure NS5A/B RAS at failureFirst salvage DAADuration (weeks)Adverse Events Grade 3 or 4Virologic outcomeM561aYesColonYesSOF/IFN/RBV12NoNoSOF/LDV24NoSVR24M871bYesHCCNoSOF/SIM12NoNoSOF/LDV/RBV24NoRelapseM651aYesDLBCL, HCCNoSOF/LDV12NoQ30RSOF/SIM/RBV24NoRelapseF563aNoDLBCLYesSOF/RBV24NoNoSOF/DCV/RBV24NoSVR24M581aNoHCCNoSOF/LDV12NoQ30Q/H, Y93HSOF/SIM/RBV24NoSVR24M631aYesHCCYesSOF/LDV24NoQ30RSOF/VEL/RBV24NoRelapseM661aNoSCCNoSOF/LD12Q80K, D168EM38A, Q30HELB/GZV/RBV24NoRelapseDCV, daclatasvir; DLBCL, diffuse large B-cell lymphoma; ELB, elbasvir; GZV, grazoprevir; HCC; hepatocellular carcinoma; LDV, ledipasvir; RBV, ribavirin; SCC, squamous cell carcinoma; SIM, simeprevir; SOF, sofosbuvir; SVR24, SVR at 24 weeks.
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