Last Updated: 2010-12-30 18:55:16 -0400 (Reuters Health)
By Scott Baltic
NEW YORK (Reuters Health) - Patients with cirrhosis are at a significantly higher risk of cancer - not just hepatocellular carcinoma (HCC) but extrahepatic cancers (EHC) too - and a new study by U.S. researchers adds to what's already known about those risks.
One of the study's most striking findings was that cirrhosis etiology was a major factor in cancer risk.
Patients with hepatitis B or C cirrhosis (with or without alcohol use) had a five-year risk of HCC of 11.2%. Those with primary biliary cirrhosis, primary sclerosis cholangitis, alpha-one antitrypsin deficiency-related cirrhosis or alcohol-related liver disease, however, had only a 3.4% five-year probability of HCC.
In contrast, the risk of EHC was highest in patients with primary biliary cirrhosis or alcoholic cirrhosis.
For analysis of EHC risk, the researchers followed 952 patients with cirrhosis; for HCC risk, they followed 797 (after excluding patients who were positive for HCC on index CT screening or who were found to have HCC within six months of enrollment).
Overall, the cirrhotic patients had a risk of HCC that was 186 times higher than in the general population. Point estimates of HCC incidence at one, three and five years after a first negative CT scan were 1.2%, 4.4% and 7.8%, respectively, according to lead author Dr. Ken Berman of the University of Colorado School of Medicine, Denver and colleagues.
The cohort's risk of EHC was nearly double that of the general population. Point estimates of EHC incidence at one, three and five years were 2.2%, 4.5% and 6.8%, respectively. The most common EHCs were breast cancer, lung cancer and lymphoma, the research team reported online December 21st in the American Journal of Gastroenterology.
The results do not support "enhanced screening for any particular EHC in an otherwise asymptomatic patient with cirrhosis," Dr. Berman told Reuters Health by e-mail. But, he added, they do suggest a need for "heightened awareness for early warning signs of cancer in these patients."
The researchers say theirs is the first study to evaluate EHC risk in a cohort of patients with cirrhosis of all etiologies in the United States.
Both male patients and older patients were significantly more likely to be diagnosed with HCC during follow-up.
Am J Gastroenterol 2010.
Last Updated: 2010-12-30 18:55:16 -0400 (Reuters Health)
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Sovaldi (Sofosbuvir) Is Now FDA Approved
Hepatitis C- Gilead's Sovaldi (Sofosbuvir) Is Now FDA Approved
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Gilead said Friday it would price the drug at $84,000 for one 12-week supply. Patients with a less common subtype of the disease may need to take the drug for 24 weeks, raising the cost to $168,000 for one course of treatment. Drugs already on the market run between $25,000 and $50,000 for a course of treatment.
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Johnson & Johnson's protease inhibitor OLYSIO (Simeprevir) is approved for the treatment of HCV genotype 1, in combination with peginterferon alfa and ribavirin in adults with compensated liver disease, including cirrhosis, who are treatment-naïve or who have failed previous interferon therapy (pegylated or non‑pegylated) with ribavirin.
Simeprevir was approved in Japan this past September , and in Canada on November 20th.
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HCV Drug Olysio (simeprevir) - The New Kid On The Block
OLYSIO (Simeprevir) Cost? - Janssen has priced Olysio at a wholesale acquisition price of $22,120 per bottle of 28 capsules (150 mg capsules), which is an approximately one-month supply. That's roughly $66,360 for a three-month course.
Lessons Learned - An important lesson we learned from these drugs may serve as a reminder for future DDAs, that is, once telaprevir and boceprevir were used in larger groups of patients, or in "real-life" settings - outside clinical trials, new response rates and adverse effects began to emerge.
Simeprevir drug–drug interactions - Simeprevir has a list of medications that can cause drug–drug interactions Other medications can interfere with the way DDAs are metabolized. The drug–drug interactions can either increase drug concentrations which may cause toxicity and lead to side effects, or decrease drug concentrations leading to a loss of efficacy.
Off Label Use - Simeprevir and Sofosbuvir? - Paul Sax, Editor-in-Chief at NEJM Journal Watch wrote an article this past summer on the possibility of combining simeprevir and sofosbuvir with or without ribavirin, to create an off label interferon-free regimen....
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How Soon Should I Get Tested After Exposure ?
After the exposure (especially if the blood exposure involved another person known to have the hepatitis C virus), it is recommended that testing for the hepatitis C antibody be performed at 4 to 6 months after the exposure OR that testing for the hepatitis C virus itself (a test often called an HCV PCR or hepatitis C viral load test) be performed 4 to 6 weeks after the potential exposure. These tests are done to determine whether or not hepatitis C infection has occurred as a result of the exposure.;
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- New HCV Drugs
- Keeping current on the potential arrival of new improved hepatitis C drugs. As once a hepatitis C patient myself (I successfully treated the virus with standard HCV therapy in 2000) I understand the difficult decisions and overwhelming fear that ensues after being diagnosed with this serious and life-changing disease. This blog serves as a starting point for information on the rapidly evolving number of new agents in development to treat hepatitis C. Tina