Patient case: 70-year-old male with melanoma; genetic feature: NF1 truncation

Clinical trial: A Phase 2b, Safety and Efficacy Study of Boceprevir in Patients Coinfected With HIV and Hepatitis C (P05411 AM4)

Summary: The primary objective of this trial is to compare the efficacy of boceprevir (SCH 503034) 800 mg three times a day (TID) orally (PO) in combination with peginterferon alfa-2b (PegIFN-2b) 1.5 µg/kg weekly (QW) subcutaneously (SC) plus weight-based dosing (WBD) of ribavirin (RBV) (600 mg/day to 1400 mg/day) PO to therapy with PegIFN-2b + RBV alone in adult participants coinfected with human immunodeficiency virus (HIV) and previously untreated chronic hepatitis C virus (HCV) genotype 1.
  Boceprevir is a potent, orally administered, novel serine protease inhibitor, specifically designed to inhibit the HCV nonstructural protein 3 (NS3) protease and, thereby, inhibit viral replication in HCV-infected host cells. The mechanism of inhibition represents a new mechanism of action compared to both interferon alfa and ribavirin. Based on previous experience with PegIFN-2b and RBV in combination with boceprevir in the HCV-monoinfected population, this combination treatment is expected to provide significant benefit to the HIV/HCV coinfected population. Given the high unmet medical need of these participants and the benefit of the addition of boceprevir to PegIFN-2b/RBV, it is important to demonstrate the safety and efficacy of boceprevir in combination with PegIFN-2b/RBV in participants coinfected with HIV/HCV.
  This is a randomized, multi-center trial, double-blinded for boceprevir or placebo in combination with open-label PegIFN-2b/RBV in participants coinfected with HIV and previously untreated chronic HCV (genotype 1), to be conducted in conformance with Good Clinical Practice (GCP). This trial consists of two arms, one control arm (Arm 1) and one experimental arm (Arm 2). Participants in the control arm (Arm 1) may receive boceprevir/PegIFN-2b/RBV via a crossover arm.


Eligibility: Inclusion Criteria:
  -  >=18 and <=65 years of age
  -  Body weight >=40 and <=125 kg
  -  Documented history of HIV infection for greater than 6 months prior to Day 1
  -  On an optimized anti-retroviral treatment regimen (OTR) with stable HIV disease with CD4 >=200 cells/µL and HIV-1 RNA viral load <50 copies/mL
  -  Documented chronic hepatitis C (CHC) genotype 1 infection (greater than 6 months prior to Day 1)
  -  Use of acceptable methods of contraception 2 weeks prior to Day 1 and at least 6 months or longer after treatment
  -  Liver biopsy with histology consistent with CHC and no other etiology
  Exclusion Criteria:
  -  Participants who received prior treatment for hepatitis C other than herbal remedies except those with known hepatotoxicity
  -  Coinfected with hepatitis B virus (Hepatitis B surface antigen (HBsAg) positive) and/or demonstrating signs and symptoms consistent with concomitant infection
  -  Evidence of decompensated liver disease
  -  Participants who have changed their anti-retroviral regimen within the last 3 months prior to Day 1 or had first initiated anti-retroviral therapy within the last 6 months prior to Day 1
  -  Use of certain HIV medications will not be allowed. Medications will be reviewed by the Investigator
  -  History of clinically significant opportunistic infections (except oral thrush) within the last year prior to Day 1
  -  Current evidence of substance abuse within 3 years of the Screening Visit
  -  History of a clinical diagnosis within the past 6 months of substance abuse prior to Day 1
  -  Participants receiving opiate agonist substitution therapy but not enrolled in an opiate substitution maintenance program
  -  History of marijuana use deemed excessive by the Investigator
  -  Infected with HIV-2
  -  Use of any HIV protease inhibitor without the coadministration of ritonavir within one month of Day 1 and throughout the period of the trial
  -  Participants receiving any of the following medication(s) within 2 weeks prior to the Day 1 visit: alfuzosin, antiarrhythmics (amiodarone, bepridil, flecainide, propafenone, and quinidine), ergot derivatives, cisapride, lovastatin, simvastatin, pimozide, triazolam, and orally administered midazolam.
  Key Laboratory Exclusion Criteria:
  -  Hematologic, biochemical, and serologic criteria (growth factors may not be used to achieve trial entry requirements):
  -  Hemoglobin <11 g/dL for females and <12 g/dL for males
  -  Neutrophils <1500/mm^3 (blacks/African-Americans: <1200/mm^3)
  -  Platelets <100,000/mm^3
  -  Direct bilirubin >1.5 x ULN (upper limit of normal) of the laboratory reference range. Total bilirubin >1.6 mg/dL unless history of Gilbert's disease or antiretroviral regimen contains atazanavir. If Gilbert's disease is the proposed etiology, this must be documented in the participant's chart
  -  Alpha fetoprotein (AFP):
  -  AFP >100 ng/mL OR
  -  AFP 50 to 100 ng/mL (requires a liver ultrasound and participants with findings suspicious for hepatocellular carcinoma are excluded)

Relevance to patient case: not relevant