Victrelis Day 4

[sandysf]

After 8 weeks of SOC, started Vic on Monday.  ANC was already in the tank at 400,  did a neupogen shot on Monday too.   Only noticeable sides so far from Vic were bad taste in mouth, dry mouth (feel very thirsty all the time, even though drinking more than half my body weight every day)  diarrhea first couple days.   The thing that concerns me is my platelets which were 205 at baseline and 118 on Monday before Vic, dropped to 79 on Day 4.   Significant drop in such a short time isn't it?

[flcyclist]

If insurance is covering, may not be a big deal, but you still might save some time.  If you decide to change, you will need the doc to rewrite the script before Quest will run it.

Hepatitis C Viral RNA, Quantitative TMA - see link for codes
http://www.questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?fn=TS_HCV_RNA_QuantTMA.htm

http://www.questdiagnostics.com/hcp/testmenu/jsp/showTestMenu.jsp?fn=10073N.html&labCode=QER

This is for the Heptimax test which explains the 2 part rollover test in the methods.
http://www.questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?fn=TS_Heptimax.htm

[sandysf]

No, i wasnt aware.  Thanks!  Hmm.. I will check the quest site to see if I can find that one and get cpt code for lab.   My insurance is paying for them.. so far.  :)

[flcyclist]

Sandy, I'm not sure if this is an option or if your are aware, but if you are paying for the heptimax test out of pocket, you might consider just doing the second part of the test to save time and money.  The first part is the RT-PCR at (<43), then they run the TMA (<5).  I don't know what the difference in just running the TMA would be, but just a thought.   Sorry if you're already aware of this.

Hope you see another UND!

[sandysf]

With my ANC at 1000 today,  Hemo told me no need to do neupogen today.  Kind of a long story, but had been in the Gilead study with 9451/Tego & SOC.  Had drugs analyzed because I was at 453 on week 4 and felt if I was getting real thing I would be UND.  Analysis came back that I was on placebo and SOC, so I switched to Vic on Monday.   Thus the Vic start 8 weeks in.  So thru the study I was getting weekly blood draws and enzymes had steadily gone down, to 15 as of 7/19 and then on 8/2 they had shot up to 122. Not sure why they tested ALT AST each week.   Since I stopped study placebos and started Vic on monday, I am wondering if I have had breakthrough.   ALT at its highest ever for me was in the 50's.  Am having doc run another PCR on monday, but.. geesh this is scary.  

[flcyclist]

My ANC also tanked (360) at 8 weeks and started neupogen 2x per week since then, also on Monday and Thursday.  I have a cbc done each Thursday prior to the neupogen shot, hoping each time I can back off to 1x per week, but it hovers at 900-1,000 and the hemo is reluctant to drop to one.  I do my inf shot on Friday evening.

I've read that switching the inf shot one day is acceptable with the docs approval, but Tues to Sun is several days at a potentially low level of inf.  I'm sure you'll discuss this with the doc first.

Are you routinely testing your ALT and AST during treatment?   Is the ALT being watched to assess the progression or regression of cirrhosis?  Just curious.  Thanks

[sandysf]

Dave, Will,

Thanks guys,  am a bit upset right now.. see most recent post..my ALT shot up to 122 from 15 in two weeks. As my VL went down I could see a perfect correlation on my ALT and now this!

I am having cbc's on monday and thursday, for now, probably because my ANC was 400 on monday.   I do my interferon shot right now on tuesday but was thinking of changing to Sunday.  

[spectda]

I know how you feel about the blood issues. I battled them all through tx. You were und at 7 weeks with soc and a very sensitive test so this is a really good sign especially since you will have 24 more weeks of vic to hopefully seal the deal.

Was the hemo experienced with HCV? It's a really good sign that you got the neupogen and no dose reduction. what days of the week are you having CBCs, and what day of the week are you doing your interferon injections? 2 blood draws a week is a lot. for me anc was really low after interferon injections each week (250-400) and off the charts the day after weekly neup injection (10,000-12,000).

[willbb]

Hi sandy..Please don"t worry that  your plats are dropping because of possible chirrosis. not from st0 in that short time  :). It is  very likely just the Peg having it"s way ...and  Like Dave says you still have lots of room . great news on the neup working too

Good luck...

[sandysf]

Dave,  Yes, I was thinking about that yesterday, you will know at end of month right?  I had my own pcr done, used heptimax!  I am a bit anxious that I am having so many blood issues so early.  I must get to SVR!  

[spectda]

Great news on the und Sandy. Was that from the trial or your own pcr? How sensitive was the pcr? Hopefully your platelets will hold on for a while or the remainder of tx.

I am doing really well, thanks for asking. about a month for my 24 week result.

[sandysf]

Dave!  How are you!  I don't know where I read that about Vic, platelets and cirrhotics.  Obviously it is not accurate, whatever it was.   I am getting blood draws twice per week at this point, so we shall see.  Just scared me a bit that platelets dropped so fast since Monday.  YES!  I was UND as of week 7.   :):)    Good news on the peg, I did full dose on Tuesday and will continue to do so as long as I can.

[spectda]

Hi Sandy-
Victrelis suppresses bone marrow production. Platelet life cycle is about 7-10 days. It seems unlikely that vic would be responsible after only three days though since it is not destroying the cells but obstructing their cycle.

I never heard that vic only effects platelets when one is cirrhotic. I was late stage 2 . My platelets were 180,000 at the beginning of tx. At week 10 (6 weeks vic) platelets were 85,000. Week 12, 65,000. They were down to 26,000 at week 43 when I stopped tx. Willing has had a substantial drop in his platelets also since adding vic, but he is getting closer to the end of tx so it's not as big a deal to tx success as it is early in tx. I believe Cando also got very low, but he was cirrhotic and started fairly low if I am remembering correctly.

They sometimes bounce back on their own and you are not close to the danger zone at this point. Of course close monitoring is important as you know well. I would hope the peg doesn't have to be reduced yet. Are you und? If it does get it can be increased again.

Good luck,
Dave

[sandysf]

Any input on 40 point platelet drop in 3 days?   A bit concerning especially since my biopsy was stage 0 two years ago.  I thought Vic trashed platelets only when cirrhotic.  My ANC is back up from 400 to 1000 after neupogen on MOnday.  But IF I wind up having to reduce Peg, is it a one time thing or when you reduce Peg do you just stay on reduced dose?