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      Concomitant use of direct-acting antivirals and chemotherapy in hepatitis C virus-infected patients with cancer

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          Summary

          Background

          Antiviral therapy improves hepatic outcomes in hepatitis C virus (HCV)-infected cancer patients. However, such patients are not treated simultaneously with antivirals and chemotherapy owing to overlapping toxicities with previous standard of care treatment of pegylated interferon and ribavirin.

          Aim

          We aimed to examine the safety and clinically significant drug-drug interactions observed in patients who received simultaneous treatment with direct-acting antivirals (DAAs) and chemotherapy.

          Methods

          Safety was determined by the presence of adverse events which were graded according to the division of AIDS Table (version 2.0). Adverse events were monitored throughout antiviral treatment and up to 3 months after its completion. Drug-drug interactions were assessed using current online databases. Sustained virological response (SVR) was defined as absence of serum HCV RNA 12 weeks after end of DAA treatment. Cirrhosis was diagnosed via imaging, biopsy or with the use of noninvasive fibrosis markers.

          Results

          Twenty-one patients received concomitant treatment with DAAs and chemotherapy between 1/2013 and 9/2016. Concomitant treatment was started either for virologic (14; 67%) or oncologic (7; 33%) reasons. DAAs used were sofosbuvir, ledipasvir, simeprevir, daclatasvir +/− ribavirin. The adverse events observed were mainly constitutional (12; 57%), haematological and gastrointestinal (7; 33% each). Physicians changed the DAA regimens in two patients (10%) in anticipation of drug-drug interactions with daclatasvir and tacrolimus. The overall SVR rate was 95% (20/21).

          Conclusions

          HCV-targeted antiviral therapy can be used concomitantly with selected antineoplastic agents under close monitoring for drug-drug interactions. This therapeutic intervention may prevent delays in the administration of chemotherapy in HCV-infected cancer patients.

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          Author and article information

          Journal
          8707234
          1160
          Aliment Pharmacol Ther
          Aliment. Pharmacol. Ther.
          Alimentary pharmacology & therapeutics
          0269-2813
          1365-2036
          6 October 2016
          11 October 2016
          December 2016
          01 December 2017
          : 44
          : 11-12
          : 1235-1241
          Affiliations
          [1 ]Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
          [2 ]Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
          [3 ]Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
          [4 ]Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
          [5 ]Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
          [6 ]Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
          Author notes
          Correspondence: Dr. Harrys A. Torres, Department of Infectious Diseases, Infection Control and Employee Health, Unit 1460, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Tel: 713-792-6503; Fax: 713-745-6839; htorres@ 123456mdanderson.org
          Article
          PMC5123740 PMC5123740 5123740 nihpa819130
          10.1111/apt.13825
          5123740
          27730654
          630a75ec-43ab-4387-bf30-abc98e943d21
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