Please interpret these liver enzyme increases. Help!

Adam, you have what is known a drug induced liver injury DILI. There is no need for a liver biopsy. You do not have any spread of metastatic disease. This is normal in the combo immunotherapy since 16% of immunotherapy pts have this. Your doctor needs to put you on higher doses of steroids and a tissue rejection drug if need be. I experienced the same after two combo infusions. After months of steroid therapy, I continued on Opdivo only. The AST numbers decrease more rapidly than the ALT because AST is produced by a quicker (30 day) cell renewal liver cells than the slower (60 day) cell renewal cells of ALT. I was also involved in a nation wide DILI liver study which involved special density liver ultrasounds and blood work over 6 months. Basically, my numbers are 13 and 17 and there are no liver issues. The issue with the steroids is that they bring their own set of side effects and it takes weeks or even months to get tappered off them.
The good thing is that even with all this your tumors will continue to shrink. I saw 50% tumor shrinkage within 2 months of starting immunotherapy and further 33% in the next two.
Best wishes for a speedy recovery,
Melanie

I am sorry that you are dealing with this, Adam. It sounds as though your doctor is being careful to determine the actual cause of your increasing liver function values rather than jumping to conclusions. It is fairly common for such values to increase with immunotherapy. However, it is also common for LFT’s to increase with liver mets. Given that you started with liver mets and your lab values were not so high, combined with the fact that you know that you have attained shrinkage of the met you had in your lung is a hopeful sign that the values have increased due to immunotherapy rather than increased metastatic disease. However, under your circumstances the fact that you have elevated AST and ALT and are on immunotherapy doesn’t equal that being the absolute cause of your condition. I am glad that your doc looks at the big picture. Still, I am hopeful that your CT will show enough shrinkage of the known mets in your liver that you can avoid a biopsy and your doctor can feel that it is reasonable to assume that your levels are due to an unfortunate side effect of your immunotherapy. Hang in there. Celeste