Hep C Discussion Forum

Members Login
Username 
 
Password 
    Remember Me  
Chatbox
Please log in to join the chat!
Post Info TOPIC: Healio - HCV+ Organ Donation
Tig


Admin

Status: Offline
Posts: 9030
Date:
Healio - TACE + Nexavar
Permalink  
 


 

TACE plus Nexavar for unresectable HCC improves progression-free survival

 

Masatoshi Kudo, MD, PhD, from the Kindai University Faculty of Medicine in Japan, and colleagues explained that because of the high tumor recurrence rate after TACE, the procedure is usually repeated many times, which can lead to deterioration of liver function.

To explore the safety and efficacy of combination therapy with Nexavar (sorafenib, Bayer), Kudo and colleagues randomly assigned patients with unresectable HCC to receive either TACE with sorafenib (n = 80) or TACE alone (n = 76).

The researchers defined progression as untreatable, or “unTACEable,” progression such as the inability for a patient to further receive or benefit from TACE for reasons including intrahepatic tumor progression, invasion or extrahepatic spread, transient deterioration of liver function to Child-Pugh C, or macrovascular invasion.

Median PFS was longer in the TACE plus sorafenib group than the TACE only group (25.2 vs. 13.5 months; HR = 0.59; 95% CI, 0.41-0.87).

Among TACE naive group, the researchers observed no difference between median PFS based on unTACEable progression in either group. However, among those with one to two previous treatments with TACE, median PFS was longer in the combination group that the TACE alone group (HR = 0.57; 95% CI, 0.33-0.99).

Kudo and colleagues noted that adverse events occurred more often in the combination group, likely due to treatment with sorafenib, but none of the events were unexpected and rates of grade 3 and grade 4 adverse events were relatively low.

“These findings differ markedly from those of previous trials testing the combination of TACE plus sorafenib in patients with HCC,” they wrote. “In contrast to [three previous] negative trials, the present trial assessed the efficacy of TACE plus sorafenib using an endpoint more suitable for a TACE combination trial, with this endpoint being consistent with those used in clinical practice.”

The researchers concluded that pre-treatment with sorafenib 2 weeks to 3 weeks before initial TACE enhanced the treatment effect of TACE through tumor vessel normalization leading to homogenous distribution of lipiodol mixed with anticancer drugs and gelatin sponge particle within the tumors. – by Talitha Bennett

Disclosures:  Kudo reports honoraria from Bayer, Eisai, Merck Sharp & Dohme, and Ajinomoto; consulting or advisory roles with Kowa, Merck Sharp & Dohme, Bristol-Myers Squibb, Bayer, Chugai and Taiho; and has received funding from Chugai, Otuka, Takeda, Taiho, Sumitomo Dainippon, Daiichi Sankyo, Merck Sharp & Dohme, Eisai, Bayer and AbbVie. Please see the full study for all other authors’ relevant financial disclosures.



__________________

Tig

63 yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 6+ years!

Hep C FAQ   Lab Ref. Ranges  HCV Resistance

Signature Line Set Up/Abbreviations   Payment Assistance

 

Tig


Admin

Status: Offline
Posts: 9030
Date:
RE: Healio - HCV+ Organ Donation
Permalink  
 


Hey Obs,

My bits, like Canuck’s are a bit crunchy, but will do in a pinch! It all depends on how badly they need the parts and pieces.

__________________

Tig

63 yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 6+ years!

Hep C FAQ   Lab Ref. Ranges  HCV Resistance

Signature Line Set Up/Abbreviations   Payment Assistance

 



Guru

Status: Offline
Posts: 623
Date:
Permalink  
 

Great to know Tig... I dont know if when I die my bits will be too old to be of use...but I sure will register to be a donor...

__________________

61 y/o, Infected via transfusion Oct'83, GT-1a, F-4 cirrhotic,
tx Holkira pak/moderiba 12 weeks

4 years.... successful dragon slayer 

Tig


Admin

Status: Offline
Posts: 9030
Date:
Permalink  
 

This is an interesting article for those interested in organ donation and recent advances in pre-transplant, anti viral administration. The sad part of the article is where they are obtaining these organs and why. The stuff is bad, real bad...

Combination therapy prevents HCV infection in non-viremic organ recipients
November 10, 2019

Jordan J. Feld, MD, MPH, FAASLD
Jordan J. Feld
BOSTON — Hepatitis C infection was prevented or rapidly cured in transplant recipients who received organs from donors infected with the virus following combined treatment with ezetimibe and direct-acting antiviral therapy, according to study results presented at The Liver Meeting 2019.

“Unfortunately, most of you know that the opioid epidemic continues and, with that, an overdose crisis,” Jordan J. Feld, MD, MPH, FAASLD, from the University of Toronto University Health Network, said during a press conference. “What has been observed is that among potential organ donors, particularly those who died of overdose, the prevalence of hepatitis C has increased dramatically.”

During the study period, transplant specialists considered donors infected with HCV for lung, heart, kidney or kidney-pancreas recipients.

To test the possibility of preventing HCV infection, recipients received Mavyret (glecaprevir/pibrentasvir, AbbVie) with ezetimibe 6 hours to 12 hours before transplantation and then daily for 1-week posttransplant.

“Ezetimibe is a cholesterol-lowering drug that is approved and quite safe, but also happens to be a ligand ... for one of the entry factors that hepatitis C uses to enter hepatocytes,” Feld explained.

Of the 13 recipients without HCV who received HCV-infected organs, four developed quantifiable viremia posttransplant with a maximum HCV RNA of 2.96 log 10 IU/mL. HCV RNA declined rapidly and was unquantifiable by day 4 after transplant in all patients.

Six other patients had detectable but unquantifiable HCV RNA at day 1 posttransplant which was undetectable by day 2 in five patients and by day 4 in one patient.

All four patients with quantifiable HCV RNA received kidney or kidney-pancreas transplants, but no other factors correlated with posttransplant viremia. Additionally, Feld reported no relapses to date with a median follow-up of 10.2 weeks (range, 1-12.1 weeks).

Medication was well-tolerated with no serious adverse events related to treatment.

“Despite the horrible tragedy of the opioid epidemic, there is some good to come from the epidemic by using these organs for others,” Feld said. “But we must also focus on what we can do about this epidemic.” – by Talitha Bennett



Reference: Feld JJ. Abstract 0038. Presented at: The Liver Meeting; Nov. 7-12, 2019; Boston.


Disclosure: Feld reports receiving grant or research support, and serving as a consultant for Abbott, AbbVie, Enanta, Gilead, Janssen, Merck and Roche.




__________________

Tig

63 yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 6+ years!

Hep C FAQ   Lab Ref. Ranges  HCV Resistance

Signature Line Set Up/Abbreviations   Payment Assistance

 

Page 1 of 1  sorted by
 
Quick Reply

Please log in to post quick replies.

Legal Disclaimer:

THIS FORUM, IT'S OWNERS, ADMINISTRATORS, MODERATORS AND MEMBERS DO NOT AT ANY TIME GIVE MEDICAL ADVICE AND IN ALL CASES REFER ANYONE HERE TO SEEK APPROPRIATE MEDICAL ADVICE FROM THEIR DOCTOR.