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Liver enzymes update

Forums General Melanoma Community Liver enzymes update

  • Post
    Beany
    Participant
      Hello everyone,

      Special thanks again to Melanie and bubbles for your input
      Had a liver biopsy and blood tests. Haven’t got word back from the biopsy yet but thankfully bloodwork is getting better without steroids. Third combo of nivo/ipi was on April 2nd. Then five days later developed diarrhea which has finally stopped.

      AST ALT
      4/15 353 658
      4/16 242 557
      4/17 174 450

      Apparently my liver mets are shrinking–very grateful.
      The doctor has me on 35mg of oral prednisone from today. I am in the hospital and they won’t let me leave until they taper the prednisone down to 20mg per day! I feel fine, so it seems too cautious. Ah well…
      What do you think? Any input grateful.
      Sincere thanks,

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    • Replies
        ed williams
        Participant
          Hi Beany, what I like about staying in hospital is the values that you just posted about AST and ALT. Unless you are driving into hospital each day you would not know these values, and diarrhea with immunotherapy can go on and on. I started in middle of October and went up and down on prednisone taper since then with one hospital visit over night to get IV steroids at 120mg/kg before being sent home after two infusions and diarrhea stopping shortly after getting IV dose. I am now in the home stretch I think being down to 5mg/kg this week and went in yesterday for blood work and cortisol level looks good so I am hoping early next week to get green light to finally stop prednisone. Glad to hear liver mets are shrinking and blood work is improving and good luck with the taper. Oh one last thing, I could not control the hunger while on prednisone and gained a ton of weight so getting off steroids quickly under supervision might save you some extra pounds!!! Ed
            Beany
            Participant
              Hello Ed,
              First, thank you for the info–encouraging.
              What do u think about 35mg? Is that high dose? Will I really get that hungry? Also, how do you guess they will taper me off? 35mg, 25mg, 15mg, etc., or more quickly?
              Sincere thanks,
              Adam
              ed williams
              Participant
                Hi Beany, my oncologist started me off at 60 mg per day and we went up and down like a roller coaster for a few months until they finally decided to hit it with 120mg IV steroids for a couple of days in hospital then slow taper (pill form of prednisone) over about 1 and a half months. It is working finally and from what I have read and watched from some of the leading experts in melanoma field, hitting it hard with 1 to 2 mg/kg off the start is the way to go. Now, I was considered grade 3 colitis and the dose of 1-2 mg/kg is recommended for my particular situation, not sure what guidelines your oncologist is following by using 35mg, would be a good question to ask! I would assume they have graded your situation to be a lower grade maybe grade 2, but I am just guessing. Here is a link that kind of spells out guidelines that oncologist’s should be following. https://www.uptodate.com/contents/toxicities-associated-with-checkpoint-inhibitor-immunotherapy
              Bubbles
              Participant
                Here is a link to a post I wrote regarding a treatment algorithm for immunotherapy side effects, including hepatic ones: http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/07/excellent-pdf-on-how-to-deal-with.html

                There is a link within to the pdf on which it is based. Hope that helps. Celeste

                  Beany
                  Participant
                    Thanks so much Ed and Celeste,
                    Really good of you. The liver doctor here said he was working on a formula of. 5 per kg. Perhaps because my levels started to drop by themselves without any steroids?
                    Beany
                    Participant
                      Just read the links by Ed and Celeste. I was 3-4 stools a day so I guess that puts me at grade 1. Also, the doctor said the CT didn’t show any inflammation. Maybe that is why he went for 35mg per day.
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