296 - Successful Liver-Directed Gene Delivery by Ercp-Guided Hydrodynamic Injection

reviewer.Random-effects model was used to estimate pooled SVR.Meta-regression was performed to determine how HCC affects SVR.Results: A total of 34 studies with 2,222 HCC and 31,801 non-HCC treated patients were included.The overall SVR rate in HCC patients was lower than in those without HCC (89.5 vs. 93.4%,p=0.0004) (Fig. 1, top panel).On meta-regression analysis, HCC patients had 5.07% (95%CI 0-8.01) reduction in SVR rate compared to non-HCC patients overall.However, patients at the time of treatment with active HCC (viable tumor on imaging) (n=217) had a 20.6% ) reduction in SVR rate compared to patients with inactive HCC (absence of residual tumor/ complete necrosis) (n=940) (71.5 vs 93.8%, p<0.0001).HCC patients treated with sofosbuvir (SOF)-based regimens overall ( I 2 =76.8%, p<0.01) or ledipasvir (LDV)/SOF ( I 2 =82.7%, p<0.01) had lower SVR than those without HCC ( I 2 =95.6% and I 2 =95.8%, both p<0.01); however, heterogeneity was high.Heterogeneity for subgroup analysis of patients treated with daclatasvir/asunaprevir (DCV/ASV) (all from Japan) was lower and showed similar SVR between HCC (I 2 =34.6%, p=0.14) and non-HCC patients ( I 2 =66.4%, p<0.01).SVR was similar in HCC and non-HCC patients treated with paritaprevir/ritonavir, ombitasvir ± dasabuvir (2D/3D) ± ribavirin (all from non-Asia centers) though there were only 101 HCC patients in this analysis.For GT1 patients (Fig. 1, bottom panel), there was no statistically significant differences in SVR between HCC and non-HCC patients within Asia or within US/Europe/Australia. Conclusion: Overall, SVR was lower in HCC compared to non-HCC patients especially in those with active HCC.HCC treatment should be considered prior to DAA therapy.Additional large cohort studies or individual participant data meta-analysis are also needed to identify predictors for treatment failure in DAA-treated HCC patients.