Hi Adam. If you remember, I recently told you that this would happen on one of your previous posts. This is because there are two types of cells. Fortunately, liver is an organ which can regenerate itself. One cell type produces AST and these cells regenerate quickly within days thus AST falls quickly however ALT is produced by another type and these regenerate every 30 days or so thus ALT is much slower to fall and takes more time. It is for this reason that you see AST falling much quicker than ALT. Give these cells time to regenerate. I know that you are in the hospital and all but your numbers are not extremely high and the important thing is that they are both on the downward trend. Steroids are terrific but they have their own set of side effects and they work counterintuitive to immunotherapy. Your doctor seems to be extremely careful and knowledgeable, so I would be patient and let him do his thing. Meanwhile, the cells will heal. If the numbers increase, the steroid dose can be increased. Also, once a definite downward trend is established, you can be released and can get twice weekly blood tests and eventually weekly. I understand your concern because I was in your shoes. My thoughts at the time were o.k., lets knock these enzymes down ASAP and get back on the immunotherapy bandwagon. Stop waisting precious time. Well, in retrospect I was wrong. The drugs are shrinking your tumors and while the enzymes are high, they are not excessively high and are on the downward trend, so be patient and let the tumors continue to shrink. Otherwise, steroids will counteract the drugs and the shrinkage will eventually stop, or dramatically slow down. This fiasco took 4 months in my case. Once I restarted Opdivo only, tumors are only shrinking minimally(11 %) and some not at all. Prior on a combo, they were shrinking (50% and 33% in two months and four months respectively following initial infusion). Knowing what I know now, I wish that I was more patient with the lower steroids.
Patience is a virtue.
Melanie
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