Tuesday, February 21, 2017

Hepatitis C Treatment Works for Follicular Lymphoma?

A reader named Ilia posted a comment yesterday about a possible treatment for Follicular Lymphoma:

I would like to get your opinion on something more exciting than watching and waiting - how about a complete remission of FL following anti- viral therapy for Hepatitis C. It was published in New England Journal of Medicine in October and would not drawn my special attention except one of the authors is Adreshna.

I hadn't heard of this article, so I thought it was worth looking into, and writing about.

But this is also a good time to remind everyone of something. When I'm asked for my opinion on something related to Follicular Lymphoma, I think it's important to remind everyone that I am not an oncologist, or a medical doctor of any kind. I'm not a biologist, or scientist, or researcher. I like to call myself a Cancer Nerd. I'm someone who has an interest in cancer, especially Follicular Lymphoma, and I have enough of a background in science to be able to understand medical journal articles and comment on them. So my opinion is only worth so much. If I'm "giving my two cents," as the saying goes, there are plenty of experts whose opinion on FL is worth two dollars, or pounds, or euros, or whatever.

So as long as we're straight on that, let's get to Ilia's comment.

The piece did indeed appear in the prestigious New England Journal of Medicine last October. It's called "Remission of Follicular Lymphoma after Treatment for Hepatitis C Virus Infection."
But there's an important distinction between this study and many others that appear in medical journals. Most of the articles that I comment on are peer-reviewed studies. That means they report on clinical trials or other research, and before it gets published in the journal, it is approved by some other experts in the field. They make sure that the trial was set up properly, and the results and conclusions are really what the authors say they are. Peer-reviewed articles are the gold standard -- you can trust what they say.

On the other hand, the article on Hepatitis C treatments is labeled "Correspondence" -- a letter to the editors. Most of the time, correspondence is a comment on an article that the journal published, though sometimes the letter might describe an interesting medical situation. It's a way of getting other doctors or researchers interested in exploring the subject further.

In this particular letter, the authors are doing just that -- just describing an interesting situation. As the title implies, the interesting situation is that a patient who had both Follicular Lymphoma and Hepatitis C. The patient was given treatment for the Hepatitis, and it put the Lymphoma into remission.

The important thing about this (and maybe why there wasn't a bigger deal made of it) is that the letter describes ONE patient. Clinical trials that result in a treatment being approved will often involve hundred of patients. That's the only way to make sure that the treatment will work on a large number of patients. ONE patient won't prove anything -- but it might get enough people interested to explore it more.

And that's just what happened here. There is a clinical trial in the U.S. that is looking into the Hepatitis C treatments Sofosbuvir and Ribavirin, and whether or not they will help with Follicular Lymphoma and other indolent lymphomas. The two treatments are anti-viral agents -- in different ways, they mess with the viruses that cause Hepatitis C. Ribavirin, for example, messes with RNA , which is necessary for DNA to copy itself, and thus for a virus to copy itself. I don't know the exact way that it works with lymphoma, but it makes sense that it messes with cancer cells trying to copy themselves.

So that's where we are with this potential treatment. It's an early trial -- only 21 patients are being recruited, and it will be at least a year before any results are in.

So Ilia, here's my opinion -- it looks promising enough for a trial. Not all trials are successful -- if they were, we'd have a whole lot more treatments than we do.

But that doesn't mean I'm not hopeful about it.

Thanks for making me aware of. I'll be sure to keep an eye on possible results when they come in.


ilia segal said...

Thank you for your post - once again yor perspective and clear deep understanding of FL served me and the entire FL community that follows you. I would'nt have gottent the information about the ongoing anti viral trial from the people I see and correspond with. So let's hope for better things to come.

Lymphomaniac said...

Thanks again for the info on the treatment, Ilia. And we will see better things in the future -- no doubt!

Anonymous said...

This is quite interesting. It could be that particular person had been having some sort of treatment for FNHL prior to Hep C treatment, thus the appearance of cause and effect.
I think it would be amazing if the clinicals pointed to the Hep C treatment working on Follicular.
Let's all hope for good news. I keep in mind what I read somewhere, maybe even from you, Bob: since the mapping of the human genome, cancer research has exploded!
Thanks again

ilia segal said...

That particular subject did not have any Fl treatment.He was diagnosed in 2014 with both conditions and finished HepC treatment in September of 2014. , 2 month later Ct showed good partial responce and 7 month later PET showed no residual disease.
One of the authors is Kirit Adreshna - a real Lymphoma Rock Star
I wonder if this treatment could work for non- hepatitis C positive patients.

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