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Gene therapy breakthrough
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| Posted on Fri, Jun. 18, 2004 | |
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DALLAS - (KRT) - In less than an hour, tiny radioactive glass beads traveled through Mike Chapman's bloodstream, toward the grapefruit-sized tumor on his liver. Once trapped inside the small blood vessels of the tumor, the SIR-Spheres began to shrink the tumor. If he is lucky, the tumor will shrink enough to make him a transplant candidate. It's the only real shot at long-term survival for Chapman, who went decades without knowing the hepatitis C virus was destroying his liver. For Chapman, 51, the therapy also allows him to get on with his life without any debilitating side effects. "I could have gone back to work the next day," he said. "But I blocked off a couple of days just to be on the safe side." Chapman, of Irving, Texas, is one of the first people in Texas to undergo the new therapy to treat liver cancer, according to officials at the Liver Institute at Methodist Dallas Medical Center. His doctors imported the spheres from Australia, where the treatment is being used in clinical trials. Hepatitis C, which Chapman contracted from a blood transfusion after a motorcycle accident in 1971, is the most common cause of primary liver cancer, said Dr. Reem Ghalib, medical director at the Liver Institute. In the United States, an estimated 3.9 million people have hepatitis C, according to the Centers for Disease Control and Prevention. Of the 5,670 liver transplants in the United States last year, 1,873 were for people with hepatitis C; 435 people had liver cancer, according to the United Network for Organ Sharing. The antiviral drugs interferon and ribavirin have been successful in treating hepatitis C and may also prevent cancer. But many people who were exposed to the virus in the 1960s and '70s - most often through blood transfusions or IV drug use - don't know that they've been infected until it's too late. "The challenge is finding people when they are asymptomatic and in the early stages," said Ghalib, also a physician at Methodist Health System. "Cirrhosis can be prevented if we treat hepatitis C early, before scarring develops." Chapman learned that he had the virus three years ago when his esophagus started bleeding. Like 80 percent of those infected with the virus, he had no symptoms. "One day I was feeling fine," he said. "The next day a vein burst and I was bleeding profusely." Chapman's liver was badly scarred. He went on with his life, working as an aircraft electronics technician for Honeywell, but he often felt fatigued and worried about his health. "The year after I knew I had hepatitis I ended up in the emergency room twice thinking I was dying," he said. In January, Chapman learned he had liver cancer. Although treatment options include chemotherapy, surgery is considered the best way to treat this type of cancer. In many cases, a patients' liver has deteriorated to the point where it's not possible to cut out part of the organ and a transplant offers the best chance of survival. In the 1980s, doctors began performing transplants on people with liver cancer. Only about 30 percent of patients survived five years, according to the American Cancer Society. Today, about 60 percent survive that long. Each transplant center has its own criteria for organ recipients. People with liver cancer are considered for a transplant based on the individual circumstances, said Pam Silvestri, a spokeswoman for Southwest Transplant Alliance. On a transplant list, cancer patients are often classified as having an urgent need. Chapman's tumor could not be surgically removed. That's the case for about 80 percent of liver cancer patients, according to the American Cancer Society. But he could qualify for a liver transplant if the tumor's size is less than 5 centimeters, about 2 inches, and the malignancy has not spread. During the therapy that Chapman is undergoing, the spheres are slowly injected into the artery that supplies blood to the tumor, said Dr. Travis Van Meter, an intervention radiologist for Methodist Health System and one of Chapman's doctors. For a short period, the patient has a little radioactivity in his body, but the tumor is exposed to a higher dose, he said. As the tumor tissue dies, patients might get fatigued or experience a low-grade fever. But Chapman, who had the procedure April 18 at Methodist Dallas Medical Center, did not experience those effects. He won't know for three to six months if the therapy shrank the tumor, but he's optimistic. "I'm hopeful that this is going to take care of it," he said. --- FACTS ABOUT HEPATITIS C _ Hepatitis C is the most common chronic blood-borne viral infection in the United States. _ Symptoms include jaundice, fatigue, dark urine, abdominal pain, loss of appetite and nausea; 80 percent of those infected have no symptoms. _ The risk is highest for injecting drug users and recipients of clotting factors made before 1987. Recipients of blood or organs before 1992 have an intermediate risk. _ The virus is treated with a combination of interferon and ribavirin. _ The hepatitis C virus is the most common reason for liver transplantation among adults. _ An estimated 3.9 million Americans have the hepatitis C virus; of those, 2.7 million have a chronic infection. SOURCE: Centers for Disease Control and Prevention --- © 2004, Fort Worth Star-Telegram. Visit the Star-Telegram on the World Wide Web at http://www.star-telegram.com. Distributed by Knight Ridder/Tribune Information Services. |
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Mitchell Shiffman and colleagues report results from the first 604 patients enrolled into the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial.
CHRONIC HEPATITIS C VIRUS (HCV) INFECTION
Peginterferon alfa-2a and ribavirin treatment of nonresponders. Mitchell Shiffman and colleagues report results from the first 604 patients enrolled into the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial. At entry patients were HCV RNA positive, had not responded to interferon-based therapy, and had bridging fibrosis or cirrhosis on liver biopsy. Patients were treated with peginterferon alfa-2a 180 ug/wk plus ribavirin 1,000-1,200 mg/d. At wk 20, 35% of patients did not have detectable serum HCV RNA and thus continued treatment for a total of 48 wk. Eighteen percent of patients had a sustained virological response (SVR) 24 wk after the completion of 48 wk of therapy. Factors associated with an SVR were: 1) previous treatment with interferon monotherapy; 2) infection with genotypes 2 or 3; 3) lower AST/ALT ratio; and 4) absence of cirrhosis. Reducing the dose of ribavirin to £60% of the starting dose during the first 20 wk of therapy was associated with a reduced SVR (21% vs. 11%). This study demonstrated that therapy with peginterferon alfa-2a plus ribavirin can induce SVR in 18% of patients who did not respond to previous interferon-based therapies. (Shiffman ML, et al. Gastroenterology 2004;126:1015-1023)
Reviewed June 05 2004
