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Receiving Chemotherpy with HCV
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Receiving Chemotherpy with HCV

I am an RN who was diagnosed with Hep C genoype 3a with a high viral load about a year ago.  I began to see a Heptologist who did a liver biopsy (Grade 2 Stage 1).  He wanted to put me in the Albuferon study  Unfortunately, three months ago I was diagnosed with stage II colon cancer.  I had to have surgery and all of the Cancer was removed.  This removed me from any type of study and put HCV treatment on hold  I will have to do six months of Chemotherapy (Folfox 6 - Oxaliplatin and 5FU).  My Oncologist spoke with my Heptologist, and the Heptologist gave the OK to start Chemo; however, the Heptologist said it would raise my viral load.  Does anyone have any info on if the chemo will hurt my liver and advance the HCV ?  I will be able to start treatment for HCV after chemotherapy Thanks
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Avatar_m_tn
Hepatic dysfunction during and after lymphoma chemotherapy in patients with hepatitis C - http://www.medscape.com/medline/abstract/16917409

BACKGROUND: Hepatitis C is one of the most common causes of chronic liver disease. The literature regarding hepatic dysfunction in Hepatitis C patients during and after chemotherapy is limited. PURPOSE: The goal of this study was to determine the incidence of hepatic dysfunction in Hepatitis C positive patients during and/or after chemotherapy for lymphoma. METHODS: A retrospective chart review was performed. Patients included in the study were anti-hepatitis C virus positive patients treated with chemotherapy for lymphoma at the BC Cancer Agency since 1999. Serum transaminases and bilirubin were the primary criteria used to define and evaluate severity of hepatic dysfunction. Information regarding clinical outcomes was also collected. RESULTS: Forty-one eligible patients were identified. Twenty-four patient charts had sufficient information for review. Four patients met criteria for acute chemotherapy-associated hepatic dysfunction. No deaths secondary to acute hepatic dysfunction were identified. CONCLUSIONS: Hepatic dysfunction in patients with Hepatitis C being treated for lymphoma with chemotherapy occurs but is uncommon.

Reactivation of hepatitis C virus after chemotherapy for colon cancer -
http://www.medscape.com/medline/abstract/15191008

Hepatitis C virus (HCV) infection often goes undiagnosed in asymptomatic carriers, but may become clinically relevant during periods of immunosuppression or severe illness. We report the clinical course of HCV reactivation in a patient receiving chemotherapy for metastatic colon cancer. We also review other reports showing the significance of HCV infection in patients being treated with chemotherapy.

These are just abstracts so if you want to read the entire article you may need to subscribe and there may be a charge. I didn't spend a lot of time on this but there doesn't appear to be a lot of readily accessible information. Good luck, Mike
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Avatar_f_tn
I'm glad that your surgery was successful.  

I wish you all the best in your future treatment(s)
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Avatar_m_tn
It would seem logical that any immunosupressive treatment would encourage viral replication but I am not sure that it is that clear cut. While a high viral load is one negative predictor of successful treatment there are many other factors at play here. I will tell you that I am a liver transplant recipient with HCV as my underlying disease. Shortly after transplant I suffered acute rejection 2 times and was treated with intravenous injections of one gram of SOLU-MEDROL each time. In fact I may have had 3 rejection episodes and 3 treatments but my memory fails me right now. Anyway, these treatments are considered a very negative predictor for a positive resolution of HCV treatment and can raise the VL significantly, so they say. Yet I achieved SVR, albeit after 3 tries, but I was under dosed the first 2 because of fear of rejection. I had other negative predictors as well - diabetes, VL >1 million, >40 years of age, Genotype 1b. The point is people can and do beat the odds so please try and stay positive. I don't know what the viral  kinetics would be when Chemo and Peg/ribavirin are taken simultaneously but I would guess that you probably won't feel great. I wish you good luck whichever way you decide to go. Mike
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Avatar_n_tn
I asked of both TX's could be done concurrently and the Oncologist said that would not be possible.  The Heptologist did say that chemo would increase my viral load.  At least I am Genotype 3a. Not to offend any other genotypes
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Best of luck with your chemo.

Hope you don't mind if I ask a related question.

Does anyone know the difference between chemo and pegasys?  I thought pegasys/ribavarin was a form of chemo?  Is the big difference the addition of radiation therapy?

wyntre
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Avatar_m_tn
That sounds like the correct approach. If your VL increases you'll just knock it down if, and when you treat. Again, I wish you very good luck and I know this must be quite a difficult situation. Mike
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Thanks for your help.  I have searched for info and have had a difficult time finding anything.  My Oncologist's opinion is that I have  to take Chemotherapy regardless and I agree.I just wanted to know if it could acclerate the progression of the Hep C  My Oncologist and Heptologist didn't have an answer
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Avatar_n_tn
Pegasys/ribavarin are classified as antivirals.  Chemotheraputics are classified as an antineoplastic. At one time interfuron was classified as a chemo drug, but it is no longer
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Last year I met with an educating RN that worked for Schering-Plough. She was previously employed as a clinical RN for a large oncology group in Sacramento. She was kind enough to address our local HCV support group and do a question-answer session. When asked if our current treatment was considered chemo, she emphatically replied no. Different administration, method of action, etc.

Interestingly enough, I personally asked what the
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173975_tn?1216261375
Yikes.  these threads sure do get buried fast!

thanks for the info, and for sharing about the insurance stuff.
wyn
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