High Liver ALT and AST

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Prop321
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High Liver ALT and AST

Postby Prop321 » Wed Oct 18, 2017 10:01 pm

Hi, my wife has rectal cancer and has completed her neoadjuvant chemoradiotherapy and surgery.

She is was supposed to have her 4th Xelox on Wednesday but the oncologist postponed as her liver function test
ALT (125 U/L vs <55norm) and AST (77 vs <34norm) are very high.
She will re-do the blood test tomorrow.
Depending on result tmrw, oncologist say either reduce dosage or postpone Xelox.

Anyone has similar experience and what was the follow-up process?

Many thanks in advance.

Achilles Torn
Posts: 88
Joined: Fri Dec 16, 2016 2:41 pm

Re: High Liver ALT and AST

Postby Achilles Torn » Thu Oct 19, 2017 8:59 am

Near the end of my first 12 cycles of FolFox my ALT was 144 and my AST 103. My Onc considered them elevated but wasn’t overly concerned and I didn’t miss chemo because of it. Both went back down to near normal after Oxi was cut out. Chemo is very hard on the liver which should recover after a short break.

Hope that helps
AT
40 yo Male. BC Canada. Sigmoid Colectomy Dec. 2016
Pathology T3N2bM1 19 of 24 Nodes Positive + tumour deposits
PET scan - Para-Aortic and Iliac Lymph node spread. Stage VI.
Moderately differentiated. MSS. KRAS/BRAF Wild.
Mutations: TP53, ERBB4, MLL3, PDCD1LG2, PRKDC, SMAD3
FOLFOX Commenced Jan 9/2017 - Avastin(Bev) added after round 1.
June 2017 Dose Reduction on Round 11 due to Neuropathy.
Good PET Scan July 2017 - on maintenance 5FU/Bev every 2 weeks until progression.

mariane
Posts: 574
Joined: Sun Sep 13, 2015 6:16 pm

Re: High Liver ALT and AST

Postby mariane » Thu Oct 19, 2017 11:51 am

I had AlAT and AspAT around 400-500 during FOLFOX and FUDR given together during my treatment. My oncologist switched oxaliplatin with irinotecan and my AlAT, AspAT came back to 30-50. I received in all 8 FOLFIRI. Now they are in low 20 even less than 20.
AlAT and AspAT show inflammation, damage of hepatic cells. Hepatic cells regenerate very quickly and easily.
mom of 8 years old twins, dx @ 40 with upper rectal cancer, 10+ liver mets in 6/2015, CEA 140
chemo: 8/2015 - 10/2016 - 4xFOLFIRINOX, 2xFOLFOX, 8xFOLFIRI, 10x5FU, HAI pump -12xFUDR
4 surgeries, complete pathological response
CEA<2 since 10/2015
NED since May 2016

I praise God for every day with my family!

kandj
Posts: 200
Joined: Sun Sep 27, 2015 11:29 am

Re: High Liver ALT and AST

Postby kandj » Fri Oct 20, 2017 3:48 pm

DH has never had his chemo cancelled due to liver functions being high and his are over those numbers regularly. I was told that it was when they see them in the 5-6x the normal values that they worry. He has had the FUDR in his liver pump cancelled due to high ALP though.
wife to DH, Diagnosed at 36yo with stage 4 CRC August 2015 mom to 3 boys
numerous mets throughout liver, unresectable currently
Folfox +avastin aug 15-Nov 15
Lynch and MAP negative
Folfiri starting Jan 2016
Primary resection and HAI pump placed Dec 2015 at MSKCC, FUDR started Dec 2015
Liver resection 5/19/2016 15-20 mets removed (surgeon lost count, but it hopeful he got it all!)
Recurrence 7/2017 3 Liver mets and one possible lung met. Focusing on Liver mets for now. Back on FOLFOX to get them shrunk!

MissMolly
Posts: 423
Joined: Wed Jun 03, 2015 4:33 pm
Location: Portland, Ore

Re: High Liver ALT and AST

Postby MissMolly » Fri Oct 20, 2017 5:11 pm

Your liver enzyme levels are not a reason for concern.

I have had AST and ALT values in the low 1,000’s due to medication interaction affects. Only when the AST asks ALT values elevated into the range of 1,100 - 1,200 did my physicians become concerned.

The range of “normal” for interpretation of blood chemistry values (ex. Complete blood count or complete metabolic panel) is derived from a statistical model and bell curve that includes a large swath of population parameters to determine cut off values. Thousands (and thousands) of data points are used to establish lab ranges for each enzyme or electrolyte curried in a blood test. Lab values, as such, reflect population statistics more than individual statistics.
Karen
Devoted daughter to my father, diagnosed with stage 2 colon cancer Nov-2014.
Dear friend to Bella Piazza, former CC member.
I have a permanent ileostomy and offer advice on living with an ostomy.
I have been on Palliative Care for broad endocrine failure + Addison's disease + osteonecrosis of both hips/jaw + immunosuppression and recurrent infection x 4 years. I transitioned to Hospice Sept-2016, but it was not yet my time. I am back on Palliative Care and live a simple life due to frail health.

User avatar
CRguy
Posts: 9287
Joined: Sun Feb 10, 2008 6:00 pm

Re: High Liver ALT and AST

Postby CRguy » Fri Oct 20, 2017 7:12 pm

Your liver enzyme levels are not a reason for concern.
Karen

Prop321
I generally concur with the above quote and explanation from Karen .... BUTT

1. your LiverZymes levels are appropriate for your situation ... i.e. chemo related
2. often trends are more important than singular absolute values
3. in quoting references, we need to allow for different lab ranges and testing methodologies, which may NOT be universal for every lab or every patient on this forum.
4. YOU need to have a baseline of these levels for YOUR OWN situation, in order for the test results to be meaningful, descriptive and predictive.
5. NEVER rule out the possibility of lab errors ! ( been doing this 36 years ... AND IT DOES HAPPEN ! )
6. be mindful of reporting errors ... i.e. somewhere along the human "paper" trail a wrong comment or wrong result ends up in your file !
IT HAPPENS = IT HAS HAPPENED TO ME

SO ... I would not personally sweat the lab results just yet ... BUTT I would be vigilant and pro-active in talking with the Docs to be sure you are getting all the info correctly.

JMO

Cheers and Harmony on the Journey
CRguy
Caregiver x 3
Stage IV A rectal cancer/lung met
10 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

Prop321
Posts: 4
Joined: Thu Aug 03, 2017 9:44 am
Facebook Username: N.a

Re: High Liver ALT and AST

Postby Prop321 » Sat Oct 21, 2017 6:06 am

Many thanks for the feedback and advice.
Yesterday my wife's blood test ALT and AST was still high. The oncologist referred my wife to liver specialist. Untrasound scan was done and the liver look ok.
The liver specialists asks my wife to return in a week to re check the AST and ALT, and if levels drop, then my wife may continue Xerox.


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