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Predictors of Sustained Virological Response in Cancer Survivors with Hepatitis C Virus Infection Receiving Antiviral Therapy. Cancer Patients are a "special population" of HCV-infected & should be prioritized for treatment.
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Reported by Jules Levin
IDSA 2014 Oct 8-12 Philadelphia, PA
Parag Mahale, MBBS, MPH; Andreas Kyvernitakis, MD; Harrys A. Torres, MD. Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
"Data on treatment response to antiviral therapy (AVT) for HCV infection in cancer pts is very limited......Physicians are hesitant at treating HCV infection in cancer pts as baseline hematologic abnormalities (i.e., anemia, thrombocytopenia, neutropenia) can be exacerbated by interferon (IFN) alfa and ribavirin-containing AVT."......"AVT is feasible in cancer survivors, with genotype 1 infection being a major predictor of antiviral failure. More efficacious and better tolerated AVTs such as direct-acting antiviral agents could improve SVR in this "special population" of HCV-infected pts."
IDSA: Non-Genotype 1 HCV Predicts Sustained Virologic Response in Cancer Survivors - written by Mark Mascolini - (10/14/14)
"There was no statistically significant difference between those who achieved SVR and those who failed AVT with respect to type of previous cancer, baseline HCV RNA (mean log10IU/ml, 6 vs. 6.1;p=0.8), CD4 count (mean cells/μl, 853 vs. 710;p=0.4), BMI (mean kg/m2, 26 vs. 27;p=0.4), hepatitis B core antibody positivity (43% vs. 45%;p=1.0), and cirrhosis (9% vs. 21%;p=0.3) (Table 1).......AVT administered consisted of either combination of interferon with ribavirin (85%) or standard interferon monotherapy (15%) (Table 2)......After exact logistic regression analysis, those without genotype 1 infection (OR, 7.2; 95% CI, 2.2-55.6; p<0.001) had higher odds of achieving SVR (Figure 2)."
".....Ninety-eight HCV-infected cancer survivors received AVT during the study period.....Among the 78 pts with known treatment outcome, 27 (35 %) achieved SVR (Table1)....SVR status according to the history of cancer type are depicted in Figure 1.
......When compared to those who had SVR, more pts who failed AVT were males (44% vs. 65%;p=0.09), African Americans (4% vs. 29%;p=0.007), had more genotype 1 infection (6% vs. 69%;p<0.001), higher baseline ALT (mean IU/l, 43 vs. 71;p=0.009), higher baseline AST (mean IU/l, 46 vs. 77;p=0.006), had more leukopenia (total WBC count <4,000 cells/μl) (4% vs. 25%;p=0.05) and neutropenia (absolute neutrophil count < 1,500 cells/μl)(0% vs. 16%;p=0.09) (Table 1)"
Most patients with HCV-associated lymphoma present with mild liver disease at cancer diagnosis: A call to revise indications for HCV treatment - "Our findings suggest the need for early DAA therapy in HCV-infected patients in an attempt to eradicate HCV and prevent HCV associated NHL. Research efforts should focus on the identification of patients who are at high risk for development of HCV associated NHL & should be prioritized in the era of DAA therapy" (09/26/14) at AASLD/EASL NY HCV Conference Sept 12
Efficacy and Safety of Antiretrovirals (integrate/raltegravir vs PI & NNRTIs) in HIV-Infected Patients with Cancer.....http://www.natap.org/2013/ICAAC/ICAAC_31.htm......."Side effects occurred in 35%, 14%, 3%, and 6% of patients receiving PIs, NNRTIs, INSTIs, or combinations, respectively (P = 0.001) (Table 2).......Interruption of ARV-based treatment was less common in patients receiving INSTIs than in those receiving PIs or NNRTIs (7%, 28% and 26%, respectively).......The overall mortality rates were 46%, 36%, 13%, and 41% in the patients receiving PIs, NNRTIs, INSTIs, and combinations, respectively (P = 0.03). Progression of cancer was the most common cause of death in all treatment groups........ Raltegravir and nonnucleoside reverse transcriptase inhibitors (NNRTIs) had similar efficacy, but raltegravir was safer than NNRTIs in this population. Raltegravir was the only integrase inhibitor prescribed during the study period. Administration of an INSTI or NNRTI regimen but not a PI regimen resulted in increased safety and efficacy without causing significant adverse events in HIV- infected patients who have cancer or have undergone HSCT. When interactions of chemotherapeutic and antifungal agents are anticipated, INSTIs (specifically, raltegravir) appear to be the ARVs of choice."
Does Chemotherapy Cause Viral Relapse in Cancer Patients with Hepatitis C
Infection Successfully Treated with Antivirals? October 2013 Clinical Gastroenterology and Hepatology
Abstract
Authors have reported conflicting results on the persistence of hepatitis C virus (HCV) infection in patients having sustained virological response (SVR) to treatment. Therefore, we sought to determine whether chemotherapy leads to viral relapse in 30 HCV-infected patients who had SVR before cancer diagnosis. Half of them had hematological malignancies. Most (60%) received HCV therapy with interferon and ribavirin. Chemotherapy was started at a median of 72 months after SVR and included rituximab (27%), cyclophosphamide (23%), cisplatin (17%), or corticosteroids (37%). No patient had post-SVR viral relapse.
Therapeutically induced resolution of HCV appears to be permanent and not affected by chemotherapy.
Downlaod the PDF here
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