Treating Hispanic Patients Diagnosed With Hepatitis C Using Boceprevir
Treating Hispanic Patients Diagnosed With Hepatitis C Using Boceprevir
Hypothesis Response guided therapy improves significantly the overall SVR in Hispanics
 compared to historical control. There is no difference in SVR between patients with an
 undetectable HCV RNA at week 8 and week 28 who received a 4 week lead-in of PR plus 24 weeks
 of PR+BOC based treatment and patients with detectable HCV RNA at week 8 and undetectable HCV
 RNA at week 24 who received a lead-in of PR plus 32 weeks PR+BOC followed by based therapy
 and 12 weeks of PR.
STUDY DESIGN AND ENROLLMENT Open label single arm pilot study enrolling Hispanic patients
 with HCV genotype 1 and naive to pegylated interferon and BOC treatment.

 Definition of BOC RGT:

 All patients will receive 4 weeks of PR (lead-in), and BOC will be added at the beginning of
 week 5. Patients who have an undetectable HCV RNA at week 8 and week 24 will receive 24 weeks
 of PR and BOC (28 weeks total treatment); patients who have a detectable HCV RNA at week 8,
 but an undetectable HCV RNA at week 24, will receive an additional 32 weeks of PR and BOC,
 followed by 12 weeks of PR (48 weeks total treatment).

 Patients with cirrhosis or bridging fibrosis (Stage 4 fibrosis) will receive 4 weeks of lead
 in followed by 44 weeks of BOC and PR (total 48 weeks).
Inclusion Criteria:

 To be eligible for this trial, patients must have documentation of the following:

 -  Male or female > 18 years old

 -  HCV genotype-1 infection

 -  Liver biopsy consistent with Chronic Hepatitis C (CHC) within the last 3 years

 -  No previous treatment with any anti-HCV therapy (approved or investigational)

 -  For women of childbearing potential, a negative urine pregnancy test result documented
 within 24 hours prior to the first dose of any study drug (BOC, PEG-INF alfa-2b, or
 ribavirin). Additionally, all female patients of childbearing potential and all males
 with female partners of childbearing potential must use two forms of effective
 contraception (combined) during study treatment and for 6 months after treatment.

 -  Willingness to give written informed consent and to participate in and comply with
 requirements of the study

 Exclusion Criteria:

 Patients with any of the following will not be eligible for participation:

 -  Infection with HCV other than genotype 1

 -  History or other evidence of a medical condition associated with chronic liver disease
 other than CHC (e.g., hemochromatosis, autoimmune hepatitis, metabolic liver disease,
 alcoholic liver disease, toxin exposures)

 -  History or other evidence of decompensated liver disease (e.g., coagulopathy,
 hyperbilirubinemia, hepatic encephalopathy, hypoalbuminemia, ascites, bleeding from
 esophageal varices) or a Child-Pugh score > 6 (see Appendix 1)

 -  Infection with hepatitis A virus (HAV), hepatitis B virus (HBV), or HIV as
 demonstrated by a positive test at screening for anti-HAV immunoglobulin M (IgM)
 antibodies (Ab), hepatitis B surface antigen, anti-hepatitis B core protein IgM Ab, or
 anti-HIV antibodies

 -  History of having received IFN, PEG-IFN, ribavirin, viramidine, levovirin, or
 investigational HCV protease or polymerase inhibitors at any previous time, or any
 other systemic antiviral therapy with established or perceived activity against HCV
 within 3 months prior to enrollment.

 -  Pregnant or breastfeeding

 -  Male partners of females who are pregnant or breastfeeding

 -  Hemoglobin concentration < 12 g/dL in females or < 13 g/dL in males or any patient
 with an increased risk for anemia (e.g., thalassemia, sickle cell anemia,
 spherocytosis, history of gastrointestinal bleeding) or for whom anemia would be
 medically problematic

 -  Absolute neutrophil count (ANC) < 1000 cells/mm3

 -  Platelet count < 70,000 cells/mm3

 -  Receipt of stimulating factors such as granulocyte colony stimulating factor (G-CSF),
 erythropoietin, or other therapeutic agents to elevate hematology parameters to
 facilitate patient entry into the study

 -  Serum creatinine concentration > 1.5 times the upper limit of normal (ULN)

 -  History of severe psychiatric disease, including psychosis and/or depression,
 characterized by a suicide attempt, hospitalization for psychiatric disease, or a
 period of disability as a result of psychiatric disease

 -  Poorly controlled thyroid dysfunction

 -  History of cardiac disease (e.g., New York Heart Association functional class II, III,
 or IV, myocardial infarction within the last 6 months, ventricular tachyarrhythmias
 requiring ongoing treatment, unstable angina, or other significant cardiovascular
 diseases. In addition, patients with documented or presumed coronary artery disease or
 cerebrovascular disease should not be enrolled if, in the judgment of the
 investigator, an acute decrease in hemoglobin by up to 4 g/dL (as may be seen with
 ribavirin therapy) would not be well tolerated.

 -  History of uncontrolled severe seizure disorder within the last year

 -  Patients treated previously with protease or polymerase inhibitors

 -  Coadministration of drugs that are highly dependent on CYP3A4/5 for clearance, and for
 which elevated plasma concentrations are associated with serious and/or
 life-threatening events including those in Appendix 2.

 -  Coadministration with potent CYP3A4/5 inducers, where significantly reduced boceprevir
 plasma concentrations may be associated with reduced efficacy.