Via AndyBiotech on Twitter, here’s an interesting report from the New England Journal of Medicine. It describes a patient diagnosed with follicular lymphoma who also was positive for hepatitis C. They went through a course of Gilead’s sofosbuvir with ribavirin, and that (as it usually does) cleared the Hep C infection. What’s interesting is that at the end of the treatment the lymphoma was in complete remission as well.
The patient received a 24-week course of sofosbuvir (at a dose of 400 mg once daily) and ribavirin (1200 mg once daily) from March through September 2014. Within 4 weeks, the level of HCV RNA was undetectable. Twelve weeks after treatment ended, the HCV RNA level remained undetectable, with a normal alanine aminotransferase level and FibroScan results consistent with a high rate of sustained virologic response.
In December 2014, findings on computed tomography (CT) of the chest, abdomen, and pelvis were consistent with a very good partial response of the follicular lymphoma. Positron-emission tomography and CT in June 2015 showed normal-sized mesenteric nodes with no 18F-fluorodeoxyglucose–avid disease (Figure 1B and 1D). Immunohistochemical and flow-cytometric tests showed that the bone marrow was lymphoma-free. As of September 2016, the patient remained well, with no clinical evidence of disease recurrence.
This is probably not a coincidence, as the paper points out, because B-cell lymphoma has been associated with hepatitis C infection, and a few cases like this are actually in the literature with earlier therapies (such as interferon). But it still comes as a welcome surprise – I can certainly imagine some ways that a viral infection might lead to lymphoma, but after that happens, I’m surprised that curing the viral infection has any effect on the cancer. There’s clearly a tighter relationship between the two than my mental picture allows for, and I’ll bet that I’m not alone.