Relapser retreatment outcomes?
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From: Cactus Jammies on 5 Sep 2008 17:45 Hi, I have a meeting with my specialist next week. I am certain that we will be discussing the possibility/advisabilty of retreating with Pegetron for an extended period beyond 48 weeks. My last biopsy showed 3/3. Can anyone point me to valid statistics regarding the SVR outcome (%) at the 6 month post-treatment point for Genotype 1b's who have undergone extended retreatment? I know that RVR and EVR (four week and twelve week) negative pcr's are hoped for and may decide whether the patient would be subjected to that brew for the full (72 week + ) length of treatment. Thanks in advance cactus jammies
From: greyhackles on 6 Sep 2008 13:01 On Fri, 05 Sep 2008 21:45:24 GMT, "Cactus Jammies" <cactusjammies(a)retinal.circus.orb> wrote: >Hi, > I have a meeting with my specialist next week. I am certain that we will >be discussing the possibility/advisabilty of retreating with Pegetron for an >extended period beyond 48 weeks. My last biopsy showed 3/3. > Can anyone point me to valid statistics regarding the SVR outcome (%) at >the 6 month post-treatment point for Genotype 1b's who have undergone >extended retreatment? I know that RVR and EVR (four week and twelve week) >negative pcr's are hoped for and may decide whether the patient would be >subjected to that brew for the full (72 week + ) length of treatment. > >Thanks in advance > >cactus jammies CJ, as you've probably found, there's not a wealth of information out there dealing with extended re-treatment of relapsers since the pegylated IFNs became the standard-of-care. Indeed, I really haven't found any good studies that were structurally conceived to determine how much, for instance, a 72 week course of peg-IFN & riba improves outcomes. That said, there is a definite inverse correlation between degree of fibrosis and SVR using the 48 week regimen for tx-naive responders, and there is plenty of *conjecture* that a longer regimen could improve SVR rates in that group. Positive support for "extended therapy" is historic and ongoing: from the original studies using Pegasys & Ribavirin that had 24 week treatment g1 arms, through current trials with alternative interferons, or additive drugs such protease inhibitors, all show the benefit of longer treatment durations over shorter. Obviously, there's a "tail of the dragon" in the curve, so the degree of improvement approaches zero at some point, but there are a few studies on tx-naive g1s showing increased SVR with 72 weeks on standard therapy in the low double-digit range, so the zero-point is out beyond 72 weeks. Dr. Ben Cecil is an advocate for "individualized treatment" that includes extended regimens. It appears that his basic g1 responder-relapser retreatment game plan is to do frequent viral load testing, and add 48 weeks to the point of first undetectable status. He also likes to vary the amount of Peg to get the patient on a good VL-fall curve. I think those are good strategies, while recognizing that it isn't going to be a cakewalk. Correct me if I'm remembering this wrong (there's been a lot of folks that passed through here since you did therapy ;-) but you really didn't have a lot of early viral load testing - so you're not really sure when you went undetectable, but you know you were undetectable by week 24? If you actually went undetectable much earlier than 24 weeks, you might not be facing a whole 72 weeks. Which Peg did you do the first time: Pegasys or Peg-Intron? Would you be repeating the same Peg - or switching? fwiw, I'll keep looking for anything that might help. Cheers /greyhackles
From: john on 7 Sep 2008 08:49 On Sep 5, 5:45 pm, "Cactus Jammies" <cactusjamm...(a)retinal.circus.orb> wrote: > Hi, > I have a meeting with my specialist next week. I am certain that we will > be discussing the possibility/advisabilty of retreating with Pegetron for an > extended period beyond 48 weeks. My last biopsy showed 3/3. > Can anyone point me to valid statistics regarding the SVR outcome (%) at > the 6 month post-treatment point for Genotype 1b's who have undergone > extended retreatment? I know that RVR and EVR (four week and twelve week) > negative pcr's are hoped for and may decide whether the patient would be > subjected to that brew for the full (72 week + ) length of treatment. > > Thanks in advance > > cactus jammies Hi cactus, As i have posted before and you might remember.After 72 week treatment of infergen i finally cleared at week4.dr told me i had a 95% of SVR. week #8 still clear.Dr said 98%.she will retest at the 6 month point which is december.she is optimistic but after 3 treatments i am still nervous.......... pegasys didnt work for me,genotype 1a stage 3-4 in 2004. but when i tried infergen for the full 72 weeks with 4 weeks of pegasys mixed in at the end of treatment it might have worked. Infergen is hell i am not going to lie to you.It was the worst time in my life at the end of treatment number 3.It was tough. If you are near cirihoisis you might have to do whatever possible.For me i realized after that treatment i am done regardless of the outcome. Best wishes i am pulling for you.................... John
From: john on 7 Sep 2008 08:59 On Sep 6, 1:01 pm, greyhackles <greyhack...(a)REMOVEyahoo.com> wrote: > On Fri, 05 Sep 2008 21:45:24 GMT, "Cactus Jammies" > > <cactusjamm...(a)retinal.circus.orb> wrote: > >Hi, > > I have a meeting with my specialist next week. I am certain that we will > >be discussing the possibility/advisabilty of retreating with Pegetron for an > >extended period beyond 48 weeks. My last biopsy showed 3/3. > > Can anyone point me to valid statistics regarding the SVR outcome (%) at > >the 6 month post-treatment point for Genotype 1b's who have undergone > >extended retreatment? I know that RVR and EVR (four week and twelve week) > >negative pcr's are hoped for and may decide whether the patient would be > >subjected to that brew for the full (72 week + ) length of treatment. > > >Thanks in advance > > >cactus jammies > > CJ, as you've probably found, there's not a wealth of information out there > dealing with extended re-treatment of relapsers since the pegylated IFNs > became the standard-of-care. Indeed, I really haven't found any good studies > that were structurally conceived to determine how much, for instance, a 72 > week course of peg-IFN & riba improves outcomes. > > That said, there is a definite inverse correlation between degree of fibrosis > and SVR using the 48 week regimen for tx-naive responders, and there is plenty > of *conjecture* that a longer regimen could improve SVR rates in that group. > > Positive support for "extended therapy" is historic and ongoing: from the > original studies using Pegasys & Ribavirin that had 24 week treatment g1 arms, > through current trials with alternative interferons, or additive drugs such > protease inhibitors, all show the benefit of longer treatment durations over > shorter. > > Obviously, there's a "tail of the dragon" in the curve, so the degree of > improvement approaches zero at some point, but there are a few studies on > tx-naive g1s showing increased SVR with 72 weeks on standard therapy in the > low double-digit range, so the zero-point is out beyond 72 weeks. > > Dr. Ben Cecil is an advocate for "individualized treatment" that includes > extended regimens. It appears that his basic g1 responder-relapser > retreatment game plan is to do frequent viral load testing, and add 48 weeks > to the point of first undetectable status. He also likes to vary the amount of > Peg to get the patient on a good VL-fall curve. I think those are good > strategies, while recognizing that it isn't going to be a cakewalk. > > Correct me if I'm remembering this wrong (there's been a lot of folks that > passed through here since you did therapy ;-) but you really didn't have a lot > of early viral load testing - so you're not really sure when you went > undetectable, but you know you were undetectable by week 24? If you actually > went undetectable much earlier than 24 weeks, you might not be facing a whole > 72 weeks. > > Which Peg did you do the first time: Pegasys or Peg-Intron? Would you be > repeating the same Peg - or switching? > > fwiw, I'll keep looking for anything that might help. > > Cheers > > /greyhackles Correct me if I'm remembering this wrong (there's been a lot of folks that passed through here since you did therapy ;-) but you really didn't have a lot of early viral load testing - so you're not really sure when you went undetectable, but you know you were undetectable by week 24? If you actually went undetectable much earlier than 24 weeks, you might not be facing a whole 72 weeks. Which Peg did you do the first time: Pegasys or Peg-Intron? Would you be repeating the same Peg - or switching? fwiw, I'll keep looking for anything that might help. Cheers /greyhackles I have had early testing and i found that i cleared at 12 weeks. Is Peg-Intron = infergen???????????????? john
From: greyhackles on 7 Sep 2008 13:09
On Sun, 7 Sep 2008 05:59:50 -0700 (PDT), john <otk355(a)hotmail.com> wrote: >On Sep 6, 1:01�pm, greyhackles <greyhack...(a)REMOVEyahoo.com> wrote: >> On Fri, 05 Sep 2008 21:45:24 GMT, "Cactus Jammies" >> >> <cactusjamm...(a)retinal.circus.orb> wrote: >> >Hi, >> > �I have a meeting with my specialist next week. �I am certain that we will >> >be discussing the possibility/advisabilty of retreating with Pegetron for an >> >extended period beyond 48 weeks. �My last biopsy showed 3/3. >> > �Can anyone point me to valid statistics regarding the SVR outcome (%) at >> >the 6 month post-treatment point for Genotype 1b's who have undergone >> >extended retreatment? �I know that RVR and EVR (four week and twelve week) >> >negative pcr's are hoped for and may decide whether the patient would be >> >subjected to that brew for the full (72 week + ) length of treatment. >> >> >Thanks in advance >> >> >cactus jammies >> >> CJ, as you've probably found, there's not a wealth of information out there >> dealing with extended re-treatment of relapsers since the pegylated IFNs >> became the standard-of-care. Indeed, I really haven't found any good studies >> that were structurally conceived to determine how much, for instance, a 72 >> week course of peg-IFN & riba improves outcomes. >> >> That said, there is a definite inverse correlation between degree of fibrosis >> and SVR using the 48 week regimen for tx-naive responders, and there is plenty >> of *conjecture* that a longer regimen could improve SVR rates in that group. >> >> Positive support for "extended therapy" is historic and ongoing: from the >> original studies using Pegasys & Ribavirin that had 24 week treatment g1 arms, >> through current trials with alternative interferons, or additive drugs such >> protease inhibitors, all show the benefit of longer treatment durations over >> shorter. >> >> Obviously, there's a "tail of the dragon" in the curve, so the degree of >> improvement approaches zero at some point, but there are a few studies on >> tx-naive g1s showing increased SVR with 72 weeks on standard therapy in the >> low double-digit range, so the zero-point is out beyond 72 weeks. >> >> Dr. Ben Cecil is an advocate for "individualized treatment" that includes >> extended regimens. It appears that his basic g1 responder-relapser >> retreatment game plan is to do frequent viral load testing, and add 48 weeks >> to the point of first undetectable status. He also likes to vary the amount of >> Peg to get the patient on a good VL-fall curve. I think those are good >> strategies, while recognizing that it isn't going to be a cakewalk. >> >> Correct me if I'm remembering this wrong (there's been a lot of folks that >> passed through here since you did therapy ;-) but you really didn't have a lot >> of early viral load testing - so you're not really sure when you went >> undetectable, but you know you were undetectable by week 24? If you actually >> went undetectable much earlier than 24 weeks, you might not be facing a whole >> 72 weeks. >> >> Which Peg did you do the first time: Pegasys or Peg-Intron? Would you be >> repeating the same Peg - or switching? >> >> fwiw, I'll keep looking for anything that might help. >> >> Cheers >> >> /greyhackles > >Correct me if I'm remembering this wrong (there's been a lot of folks >that >passed through here since you did therapy ;-) but you really didn't >have a lot >of early viral load testing - so you're not really sure when you went >undetectable, but you know you were undetectable by week 24? If you >actually >went undetectable much earlier than 24 weeks, you might not be facing >a whole >72 weeks. > > >Which Peg did you do the first time: Pegasys or Peg-Intron? Would you >be >repeating the same Peg - or switching? > > >fwiw, I'll keep looking for anything that might help. > > >Cheers > > >/greyhackles > > >I have had early testing and i found that i cleared at 12 weeks. Is >Peg-Intron = infergen???????????????? >john Hi John! That's great news for you - clearing by 12 weeks is an excellent start! Peg-Intron is not Infergen. "Peg-Intron" is Pegylated Interferon alpha-2b produced by Schering Corp. "Infergen" is Consensus Interferon Alpha-1 produced by Three Rivers Pharmaceuticals. (And, fwiw, "Pegasys" is Pegylated Interferon alpha-2a produced by Roche Pharmaceuticals). Peg-Intron and Pegasys attach their interferon molecules to what is essentially a fragment of "soap" ("pegylated") to increase the time that the drugs stay in the body to nearly a week from the time of injection. Trials showed this process increased the general SVR rate two to three times over their non-pegylated predecessors (which were/are the same interferons). The major difference between Peg-Intron and Pegasys is the size of their respective "soap fragments": Pegasys uses a molecular size roughly 4 times that of the smaller Peg-Intron molecule (40k Daltons vs 10k Daltons). At this time, Infergen is only available in non-pegylated form, and thus multiple injections per week (usually daily) are required to maintain active quantities in the body at all times. However, it will almost certainly become available in a pegylated form - "Peg-Alphacon" is currently undergoing trials, which are expected to be quite positive. Anyway...Good start to your therapy! Cheers - and keep up the great work! /greyhackles |