Aa
Victrelis- lead-in PCR
Finally - I took the test 8 days ago and just got the results. After 4 weeks of Ribavirin and Interferon, my viral load is 3920 IU/mL
My pretreatment viral load was over 2,000,000 ( I got a QuantaSure and went over the upper limit of detection, but in October, 2010 it was 2,850,000). So, i got a 2-log drop. They are only looking for a 1-log drop after the lead in so I am in good shape. Interestingly, my first treatment the 4-week viral load was 2380 IU/ML so it would appear I am reponding to tx in much the same way. I was worried because my first treatment I was a grade1, stage 1-2 and now I am a grade 3, stage 3&4, so I was afraid my response would be much worse. I did Pegasys the first time, PegIntron this time.
On the week 4 CBC, my HGB has already dropped to 10.9. This is interesting because I did not get down that low until week 16 last time. My ANC is already 0.5 -- and it did not drop that low until week 15 last time. Happily the doctor does not appear to get up in arms about this ANC level -- the treating hemotologist sure got bent about it last time. I would like to hold out on the neupogen for as long as possible but want to start the procrit as soon as possible (but not yet).
I really don't feel too bad. I was surprised about the 10.9 HGB. Maybe since I knew what to expect, all the symptoms just seem like the normal way one feels on tx. I am not set to get another CBC until 10/20 which is the say day I get the 8-week (4 weeks VIC) PCR.
I am excited to say that I requested a Quanta Sure for week 2 of the VIC and they sent me orders. So next Thursday I will find out what my VL is after 2 weeks of VIC
Thanks for all your support
frjiole (bean)
My pretreatment viral load was over 2,000,000 ( I got a QuantaSure and went over the upper limit of detection, but in October, 2010 it was 2,850,000). So, i got a 2-log drop. They are only looking for a 1-log drop after the lead in so I am in good shape. Interestingly, my first treatment the 4-week viral load was 2380 IU/ML so it would appear I am reponding to tx in much the same way. I was worried because my first treatment I was a grade1, stage 1-2 and now I am a grade 3, stage 3&4, so I was afraid my response would be much worse. I did Pegasys the first time, PegIntron this time.
On the week 4 CBC, my HGB has already dropped to 10.9. This is interesting because I did not get down that low until week 16 last time. My ANC is already 0.5 -- and it did not drop that low until week 15 last time. Happily the doctor does not appear to get up in arms about this ANC level -- the treating hemotologist sure got bent about it last time. I would like to hold out on the neupogen for as long as possible but want to start the procrit as soon as possible (but not yet).
I really don't feel too bad. I was surprised about the 10.9 HGB. Maybe since I knew what to expect, all the symptoms just seem like the normal way one feels on tx. I am not set to get another CBC until 10/20 which is the say day I get the 8-week (4 weeks VIC) PCR.
I am excited to say that I requested a Quanta Sure for week 2 of the VIC and they sent me orders. So next Thursday I will find out what my VL is after 2 weeks of VIC
Thanks for all your support
frjiole (bean)
aquisi - I understand. I like treating with a hepatologist much more than with a GI. I think I would wait too.
susan400 - I didn't realize your response to INF was changing. That is kind of spooky and I wonder if you are just going to have to wait until the treatments without Interferon are available. I think you have time based on your liver damage.
specta - Yes, I will get a CBC by hook or crook this week!
susan400 - I didn't realize your response to INF was changing. That is kind of spooky and I wonder if you are just going to have to wait until the treatments without Interferon are available. I think you have time based on your liver damage.
specta - Yes, I will get a CBC by hook or crook this week!
Great response to the soc so far, much better then mine and I appear to be SVR.
Hopefully your doc will wake up and agree to monitoring your blood more often since it sounds like you are ready for procrit and probably neupogen before those blood values get much worse. Good luck on the next vl, I think you've got a great chance of an early und.
Dave
Hopefully your doc will wake up and agree to monitoring your blood more often since it sounds like you are ready for procrit and probably neupogen before those blood values get much worse. Good luck on the next vl, I think you've got a great chance of an early und.
Dave
"Is his office just too "booked?"
Hi, you are on point. There are only three Hepatoligists here in Charleston and they are bogged down, I understand I can go with any gastro doc, but I'd rather go with experience although it is an option.
Hi, you are on point. There are only three Hepatoligists here in Charleston and they are bogged down, I understand I can go with any gastro doc, but I'd rather go with experience although it is an option.
I am happy for you. It's very encouraging that you still have a good response to SOC. I used to have a good response to SOC (even though didn't clear, I was previously getting a big log drop), but that has changed as of my last TX, my SOC response was not great. So, I'm happy for you that you have this great response for you lead-in going into the Victrelis TX. I think you're going to SVR! Susan400
desrt and pcds and others.
I think you are right and I will call the doctors office Monday to get CBC orders for next week.
I think you are right and I will call the doctors office Monday to get CBC orders for next week.
vannh9 -- Welcome to the forum. A log is a 90% drop in the viral load. That is, you drop one decimal point from your current viral load. For example If my start VL was 2,850,000, a 1-log drop is to 285,000. A 2-log drop is 28,500 and a 3-log drop is 2,850. With Victrelis the purpose of the lead-in is to determine if you are responsive to the interferon. Although you can continue with a less than 1-log drop at week 4, your chances of success may not be as great as if you get the 1-log drop. Good luck on your start date coming up pretty soon. I think Pegasys is easier to handle than PegIntron.
can-do-man
Yes, I am concerned about the HGB too. And this did not even merit a call from his office. My orders for the CBC and the VL test are the day of my appontment -- so at that appointment I will not even know what the current HGB is. I am considering crossing out the VL test and getting the CBC the day before my appointment so we will have the results. Then I will ask him for new orders for the VL test and get that in Dallas at the LabCorp there. Kwo was so good with you. I sure wish they could clone him.
pcds -- I agree that weekly labs will be the norm - at least once I get on the helper drugs, but I have to admit, I don't mind not getting those pokes in the arm once a week yet.
flcyclist -- Yea, I saw that you were doing the neup already 2x a week. Hemotologists are like that - wanting to protect your blood! I would have never taken the neupogen last time if it had been my choice, but doctors rule. I am in for the 48 weeks regardless of the VL at weeks 8 and 12 due to the stage 4 dx.
aj -- hey -- did you get going on the VIC?
kat_rvk -- I tried to use bean as my screenname when I started but it was taken so i decided since I live in Texas and it is really TexMex here, I would be frijole -- a texmex bean! Bean is a take off on my maiden name and I have used it as a nickname most of my life in one form or other.
orleans -- haven't seen your name here -- where are you on treatment?
aquisi -- Glad can-do-man posted that information for you. If you don't get the 1-log drop you can still continue with Victrelis. Curious about this mysterious waiting list your doctor is referring to. Is his office just too "booked?" There is definitely no waiting for the treatment drugs. Both companies have manufactured plenty of them.
coeric -- yes, the good old days of the 2-log drop. But even back when I treated the first time in 05-06 that was old news. My doctor's office was thrilled with my viral load of 40 at week 12, but since I was active on this forum, I was crushed to not be UND. Back then those of us on the forum knew if you had any VL at week 12, you needed to extend treatment.
hector - I haven't listed to that one yet but see it in my email box. Clincial care options sure have some great information
Thanks to everyone else -- and proactive -- great to see you!
frijole (bean)
can-do-man
Yes, I am concerned about the HGB too. And this did not even merit a call from his office. My orders for the CBC and the VL test are the day of my appontment -- so at that appointment I will not even know what the current HGB is. I am considering crossing out the VL test and getting the CBC the day before my appointment so we will have the results. Then I will ask him for new orders for the VL test and get that in Dallas at the LabCorp there. Kwo was so good with you. I sure wish they could clone him.
pcds -- I agree that weekly labs will be the norm - at least once I get on the helper drugs, but I have to admit, I don't mind not getting those pokes in the arm once a week yet.
flcyclist -- Yea, I saw that you were doing the neup already 2x a week. Hemotologists are like that - wanting to protect your blood! I would have never taken the neupogen last time if it had been my choice, but doctors rule. I am in for the 48 weeks regardless of the VL at weeks 8 and 12 due to the stage 4 dx.
aj -- hey -- did you get going on the VIC?
kat_rvk -- I tried to use bean as my screenname when I started but it was taken so i decided since I live in Texas and it is really TexMex here, I would be frijole -- a texmex bean! Bean is a take off on my maiden name and I have used it as a nickname most of my life in one form or other.
orleans -- haven't seen your name here -- where are you on treatment?
aquisi -- Glad can-do-man posted that information for you. If you don't get the 1-log drop you can still continue with Victrelis. Curious about this mysterious waiting list your doctor is referring to. Is his office just too "booked?" There is definitely no waiting for the treatment drugs. Both companies have manufactured plenty of them.
coeric -- yes, the good old days of the 2-log drop. But even back when I treated the first time in 05-06 that was old news. My doctor's office was thrilled with my viral load of 40 at week 12, but since I was active on this forum, I was crushed to not be UND. Back then those of us on the forum knew if you had any VL at week 12, you needed to extend treatment.
hector - I haven't listed to that one yet but see it in my email box. Clincial care options sure have some great information
Thanks to everyone else -- and proactive -- great to see you!
frijole (bean)
Your response is a very good sign.
Hoping that by week 8 you will be undetectable!
Glad to hear the good news!
"A Practical Guide for the Use of Boceprevir and Telaprevir for the Treatment of Hepatitis C
Source: The Future of HCV Therapy With the Advent of Direct-Acting Antiviral Agents"
(European Medicines Agency (EMA) for use in the European Union)
"Treatment-Experienced Patients
Boceprevir. The prescribing information for boceprevir in treatment-experienced patients is the same for both previous relapsers and previous partial nonresponders; however, there are slight differences in the recommendations put forth by the FDA and the EMA. According to both bodies, the approved dosing regimen includes a 4-week lead-in phase with pegIFN/RBV, followed by boceprevir 800 mg 3 times daily with pegIFN/RBV for 32 weeks. The FDA recommends that for early responders (undetectable HCV RNA at Week 8 and maintained through Week 24), treatment then concludes at Week 36, but late responders (detectable HCV RNA at Week 8 but undetectable at Week 24) should receive an additional 12 weeks of pegIFN/RBV, ending treatment at Week 48. By contrast, the EMA recommends that regardless of Week 8 response, patients who have failed previous therapy should receive 48 weeks fixed-duration therapy comprised of 4 weeks lead-in followed by boceprevir plus pegIFN/RBV to Week 36 and then pegIFN/RBV for the remaining 12 weeks. Either management approach is acceptable and at the clinician’s discretion."
Hector
Hoping that by week 8 you will be undetectable!
Glad to hear the good news!
"A Practical Guide for the Use of Boceprevir and Telaprevir for the Treatment of Hepatitis C
Source: The Future of HCV Therapy With the Advent of Direct-Acting Antiviral Agents"
(European Medicines Agency (EMA) for use in the European Union)
"Treatment-Experienced Patients
Boceprevir. The prescribing information for boceprevir in treatment-experienced patients is the same for both previous relapsers and previous partial nonresponders; however, there are slight differences in the recommendations put forth by the FDA and the EMA. According to both bodies, the approved dosing regimen includes a 4-week lead-in phase with pegIFN/RBV, followed by boceprevir 800 mg 3 times daily with pegIFN/RBV for 32 weeks. The FDA recommends that for early responders (undetectable HCV RNA at Week 8 and maintained through Week 24), treatment then concludes at Week 36, but late responders (detectable HCV RNA at Week 8 but undetectable at Week 24) should receive an additional 12 weeks of pegIFN/RBV, ending treatment at Week 48. By contrast, the EMA recommends that regardless of Week 8 response, patients who have failed previous therapy should receive 48 weeks fixed-duration therapy comprised of 4 weeks lead-in followed by boceprevir plus pegIFN/RBV to Week 36 and then pegIFN/RBV for the remaining 12 weeks. Either management approach is acceptable and at the clinician’s discretion."
Hector
2 log drop!!! you go girl.
i seem to recall that in the olden times with peg and riba, a 2 log drop in 12 weeks meant that you were responding enough to continue. and here you did it in 4 weeks.
blessings
eric
i seem to recall that in the olden times with peg and riba, a 2 log drop in 12 weeks meant that you were responding enough to continue. and here you did it in 4 weeks.
blessings
eric
Thanks, good stuff, now if I could only remember things I'd be ok. lol I am documenting most of it, wealth of information from all of you on this forum.
I'm not the bean counter but you might start here, good luck to you.
"Nonetheless, the highest SVR rates were found in patients treated with a boceprevir-based regimen who experienced a ≥ 1 log decline in HCV RNA after the lead-in phase,"
This can be found under........
Predictors of Response and Early Viral Kinetics in Patients With HCV
http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%203.aspx
"Nonetheless, the highest SVR rates were found in patients treated with a boceprevir-based regimen who experienced a ≥ 1 log decline in HCV RNA after the lead-in phase,"
This can be found under........
Predictors of Response and Early Viral Kinetics in Patients With HCV
http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/HCV%20New%20Agents/Module/Practical_Guide/Pages/Page%203.aspx
"They are only looking for a 1-log drop after the lead in so I am in good shape".
That sounds real good to me, back in 2003 I did the Pegasys tx and quit after 6 weeks because of severe depression acquired from the tx. My start VL was1760000 and after the forth shot I went down to 128000, it's a 1.1 log I think, so I'm excited to hear that, my Doc is wanting me to start with Vic in a few months because of a waiting list. Frijole is that info of a 1 log drop in any of the literature? Happy for ya.
Charlie
That sounds real good to me, back in 2003 I did the Pegasys tx and quit after 6 weeks because of severe depression acquired from the tx. My start VL was1760000 and after the forth shot I went down to 128000, it's a 1.1 log I think, so I'm excited to hear that, my Doc is wanting me to start with Vic in a few months because of a waiting list. Frijole is that info of a 1 log drop in any of the literature? Happy for ya.
Charlie
I ended up on the neupogen from week 4 to the very end. tried to stop it once, no way. congrats for a good start
Sounds really promising..good luck, Bean (love the name Bean- that's what I call my cat). ☺
Congratulations, great news , this will.make tx a lot more bearable really very happy for u.
Very nice drop for the lead-in and hoping you see great results after the first two weeks of Vic. I agree with you on the ANC levels - I wish I could convince my Hemo that a 0.5 was ok :)
Does protocol call for 24 or 48 weeks for you? I'm not up on the triple therapy. Wish you the best for a successful trt with minor sides.
Does protocol call for 24 or 48 weeks for you? I'm not up on the triple therapy. Wish you the best for a successful trt with minor sides.
Weekly labs are important because these new meds and especially the Vic, cause bad anemia. Although the first month not so bad, but since you dropped your HGB so fast you want to monitor it so you get procrit as soon as possible when you go below 10. I didn't have weekly labs during my first tx, but I can see it's very important with this new med.
That is really great news and thx. for updating. Sounds like you have them on the ropes and now VIC should put them out of commission
Thanks and good luck...
Will
Thanks and good luck...
Will
Looks to me that was closer to a 3 log drop then two, very good news indeed. A little worried though about not getting another cbc until the 20th because of the HGB......... Kwo decided to start procrit after HGB went below 11 because we that tanked quick on just soc really tanked when on the VIC.
Anyway this should make shot night a little better, thats a great viral drop.
Anyway this should make shot night a little better, thats a great viral drop.
Hey Bean...I am starting treatment Oct. 13 or 14 with Pegasys/ribavarin with Vic in 4 weeks....I am new to this, so what is a 1 log...2 log?.
What should I be looking for in my VL? My starting is 2.6 million. It sounds like you are on the right path. Hoping for UND for you very soon!!!
Thanks
Vann
What should I be looking for in my VL? My starting is 2.6 million. It sounds like you are on the right path. Hoping for UND for you very soon!!!
Thanks
Vann
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