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Liver Numbers Elevated after Keytruda
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Liver Numbers Elevated after Keytruda

› Forums › General Melanoma Community › Liver Numbers Elevated after Keytruda

  • Post
    • March 2, 2017 at 7:35 pm
    Cindyco
    Participant

      Unfortunately, we were not able to get the second dose of Keytruda as planned.  We went to UCLA, but my mom's blood test showed high liver enzymes.  She is getting a full body CT scan today instead to see what is going on.  Dr. Ribas doesn't think it is hepatitis again (like it was after one dose of the ipilumumab/nivolumab), because alkaline phosphate also went up.  So now we are worried about mets, as usual.  Not sure what else could be causing the liver enzyme spike…. infection?

      We hoping that we'll be able to continue with Keytruda, since it seems to work well for others

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        • March 3, 2017 at 5:01 am
        debwray
        Participant

          Hi Cindy,

          Keytruda on its own as hepatitis is likely to have pointers such as raised last and alt. I have this on rebound after dose 3 of IPI nivo… But the steroids are bringing down the last and alt whilst all phos and gamma gt continue to increase. This is likely sure to liver damage from liver mets..they have postponed ct scan to end of March to check for progression..whilst treating ast and alt with steroid  taper. Prob also reduce inflamation from tumours too. 

          Depends on how high the other liver numbers are. Alk phos high and gamma gt high with bilirubin high points to possible blockage in bile ducts. By the time you read this Ctscan should be giving a bit more info.

          So.. In my case prob rebound hep / drug toxicity plus liver met damage. Sounds like Dr Ribas feels scan would inform decision making / point the finger.. And will then decide on action. Scan may show something going on.. Think you need to hang on for results ..in the meantime hope that raised other levels are down to your mums system attacking new tumours in the area ? He has lots of clinical experience with immunotherapy and I would be happy to follow his advice.

          Levels on these tests can go from just over uln to sway over 10 times upper limit and if one is raised way out of line with others.. Say all ohis and serum calcium it can point to bone damage.

          Blocked bile ducts.. Clay coloured stools , high bilrubin etc might indicate need to stent a bloickage..

          So lots of possibles.. and ct scan will help unravel and decide what is best to do next.  Might decide low dose steroid. Review bloods next week and decide on next Keytruda treatment then..

          And try to keep in mind that immunotherapy can kick into action after one dose or many more..all varies between individuals and liver tox may also come from other drugs given earlier in treatment. Think you probably already have a decent idea of possible causes and even if not the news we would like.. Knowing the cause does allow for better targeted treatment regardless.

          So, deep breath time for now and wait and see . Will cross my fingers and toes it is down to something good related to meds.?

          Best wishes

          Deb

           

           

            • March 3, 2017 at 6:58 pm
            Cindyco
            Participant

              Thanks Deb.  Your insight is always so appreciated.  Bilirubin was normal while AST/ALT/Alkaline Phosphate/LDH were all high.  In this forum, I've seen that this combo might mean that there are mets, like you described.  As of her December scan, my mom had the same primary mass, inguinal lymph nodes, and some tiny nodules in the lung that they can't biopsy yet.

              My mom had her CT yesterday and we're just waiting for the results to come out today.  If they don't come out today, we'll have to wait till Monday.  We would love to hope that it's just the immunotherapy attacking tumors, but we're afraid to get our hopes up. While we wait, we go back and forth with hoping that it's just hepatitis again (which means no new mets yet, but would probably mean no more Keytruda) and the alternative of progression (which may mean Keytruda doesn't work for her and we can move on or that we need more doses for it to kick in).  It is hard to wait for what might be bad news. 

              • March 3, 2017 at 8:33 pm
              debwray
              Participant

                Hi Cindy,

                Sorry for all the typos. Not good at touchscreens…

                Range on these things registering high can be from a little bit to huge…..

                Rebound ast alt can happen after taper and rechallenge with the drugs… 

                LDH can bounce around as liver side effects get treated…( mine has dropped this week on steroids.)

                I'm still working on the one day at a time approach-hoping for the best but planning for other possibles.

                The scan will only give you part of the picture…but all the pieces add info- and sometimes it is a bit of a see saw trying to get the balance between the drugs and needing to turn down the heat on the immune system.These are powerful drugs- but  in the end it is your immune system that has to do the heavy lifting..and we all work at different speeds.. PLUS side effects do demonstrate impact..so use that as something to cling to if you need it at the moment.. and your Mums care is in good hands with lots of experience…

                It is hard-     waiting – I am a very impatient patient-but sometimes delays are down to the docs exploring other options in the background – so you get a result and next steps type package at the next meeting- andsometimes its just simple delays. Seems to vary between different docs and think those on this forum probably want more info than the majority. You and your Mum are not on your own and even if your hopes do take a knock this time round  immunotherapy may show results later.  ( Not sure if it is you or me I'm trying to convince here… but drop in LDH after rebound elevated ast alt in my case was encouraging this week and doc has delayed next scan to give time to work….

                Hang on – deep breaths and deal with bad news when and if you have to…even a mixed result can have a positive spin with the hope of more good news later.. 

                Best wishes to you ,Mum and all the family– Got my positive head on tonight…

                Love from Deb

                 

                x

                 

                • March 3, 2017 at 9:35 pm
                Cindyco
                Participant

                  Thanks for the positivity. =)  Will try to keep this in mind as we wait. 

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