AST and ALT elevated?

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Punky44
Posts: 446
Joined: Mon Oct 01, 2018 4:29 pm

AST and ALT elevated?

Postby Punky44 » Mon Dec 31, 2018 11:59 am

So we just got the labs back before her 5th infusion.

Good news is CEA is down to 10.8 and RBC, WBC and platelets all good. They mentioned her AST and ALT were slightly elevated (45 and 55 respectively.) They have been normal every other time. They said it wasn’t a cause for concern at this time but that they would watch it.

Just curious if anyone else has had something similar?

Thanks and Happy New Year everyone! Really looking forward to saying goodbye to 2018.
Caregiver to my amazing mom (68 at dx)
10/1/18 DX with rectal cancer; CEA 17
T3N2M0
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
6/28/19 Reversal and port out
CEA 2.1; 1.9; 2.6; 2.8; 2.3; 2.4
Latest update: 6/20–Clear CT; 9/22—CEA 2.4

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

Beckster
Posts: 421
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: AST and ALT elevated?

Postby Beckster » Mon Dec 31, 2018 12:40 pm

As my chemo progressed, so did my ALT and AST. It did not normalize until 3 months after treatment ended. My ALP also was elevated. Now everything is back to prechemo levels.
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3 (path) G2 (pre-op)
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic reaction
1/2/17 to 6/9/17- Xeloda monotherapy
6/17,12/17,6/18,12/18, 6/19, 12/19 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8 6/20 3.0
Clear Colonoscopy 10/17, 11/19 :D

Rock_Robster
Posts: 517
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: AST and ALT elevated?

Postby Rock_Robster » Mon Dec 31, 2018 8:13 pm

My ALT and AST jumped a *lot* after the 3rd round of FOLFOX - over 500 for ALT and 300 for AST. My onc said they continue to treat people “in the thousands” provided the other liver function is OK (bilirubin, albumin, etc.) and no other physical symptoms of liver injury (which is me). He also said that transient increases in liver enzymes are common during chemo and often reverses during or after treatment. I’m also on heparin for a DVT which can cause temporary liver enzyme elevation. I believe that having the ALT higher than AST is a good thing (ideally a ratio of <0.8 ), so that’s positive. I get new bloods tomorrow so hoping it’s come down a bit as I’m hoping to be lining up for a liver resection if all goes well with next scans. Best of luck.
38M Australia
10/2018 Dx RC, 12cm high
Mod diff, EMVI+ LVI+. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0, Mar-20=2.2, May-20=1.9, Jun-20=2.1, Sep-20: 2.1
11/18 FOLFOX x6
3/19 Liver resect
5/19 25x pelvic radiation; complete met. response
07/19 ULAR w ileo, 1/27 LN+
08/19 Found liver spot
08/19 FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 Liver resect
02/20 Ileo reversed
03/20 NED (PET+MRI)
06/20 NED (CT+MRI)
07/20 Clear scope
09/20 NED (PET)

Punky44
Posts: 446
Joined: Mon Oct 01, 2018 4:29 pm

Re: AST and ALT elevated?

Postby Punky44 » Mon Dec 31, 2018 10:26 pm

Thank you. I’m actually thankful she was scheduled for a CT scan a few days before anyway so we confirmed the liver is clear before we even got the news about the elevated enzymes.

So neither of your elevations caused a delay in treatment?
Caregiver to my amazing mom (68 at dx)
10/1/18 DX with rectal cancer; CEA 17
T3N2M0
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
6/28/19 Reversal and port out
CEA 2.1; 1.9; 2.6; 2.8; 2.3; 2.4
Latest update: 6/20–Clear CT; 9/22—CEA 2.4

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

Rock_Robster
Posts: 517
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: AST and ALT elevated?

Postby Rock_Robster » Tue Jan 01, 2019 1:17 am

Punky44 wrote:So neither of your elevations caused a delay in treatment?


Correct, no delays as yet. Though I believe it’s based on the overall picture - other levels all fine, no physical symptoms of liver injury, otherwise “young” and “healthy” (both in the context!).

When I first asked about it, the oncology nurse pointed to the “normal” ranges on the blood test results and said, “see these? They don’t apply to you anymore!” It seems chemo patients have their own “normals”....
38M Australia
10/2018 Dx RC, 12cm high
Mod diff, EMVI+ LVI+. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0, Mar-20=2.2, May-20=1.9, Jun-20=2.1, Sep-20: 2.1
11/18 FOLFOX x6
3/19 Liver resect
5/19 25x pelvic radiation; complete met. response
07/19 ULAR w ileo, 1/27 LN+
08/19 Found liver spot
08/19 FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 Liver resect
02/20 Ileo reversed
03/20 NED (PET+MRI)
06/20 NED (CT+MRI)
07/20 Clear scope
09/20 NED (PET)

Rock_Robster
Posts: 517
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: AST and ALT elevated?

Postby Rock_Robster » Tue Jan 01, 2019 7:12 pm

Brief update - big drop in ALT/AST this week, down below 150/100. Treatment going ahead. Hope you guys see a similar correction.
38M Australia
10/2018 Dx RC, 12cm high
Mod diff, EMVI+ LVI+. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0, Mar-20=2.2, May-20=1.9, Jun-20=2.1, Sep-20: 2.1
11/18 FOLFOX x6
3/19 Liver resect
5/19 25x pelvic radiation; complete met. response
07/19 ULAR w ileo, 1/27 LN+
08/19 Found liver spot
08/19 FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 Liver resect
02/20 Ileo reversed
03/20 NED (PET+MRI)
06/20 NED (CT+MRI)
07/20 Clear scope
09/20 NED (PET)

lakeswim
Posts: 226
Joined: Sat Mar 31, 2018 9:37 am

Re: AST and ALT elevated?

Postby lakeswim » Wed Jan 02, 2019 9:17 am

A little late to the game given your levels came down (good news!), but they delayed my FOLFOX treatment an extra two weeks when my ALT/AST jumped. I was also having other side effects at the time.
Female - RC dgns @ 49 y
Adenocarcinoma
10-11 cm from anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept 18
Capecetabine + Radiation - 28 sessions - Oct - Nov 18
Jan 19 - MRI & flex sig show tumor gone, Chest/ab CT no change
Feb 19 - MRI & flex sig show tumor gone
W&W (must travel)
May 19 - flex Sig - looks good
Sept 19 - Chest/ab CT no change, MRI no change, flex Sig looks good
Jan 19 - flex sig - looks good
*grateful*

Punky44
Posts: 446
Joined: Mon Oct 01, 2018 4:29 pm

Re: AST and ALT elevated?

Postby Punky44 » Wed Jan 02, 2019 12:31 pm

Great news Rock Robster!

Lakeswim, what were your levels when they delayed? What were your symptoms?
Caregiver to my amazing mom (68 at dx)
10/1/18 DX with rectal cancer; CEA 17
T3N2M0
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
6/28/19 Reversal and port out
CEA 2.1; 1.9; 2.6; 2.8; 2.3; 2.4
Latest update: 6/20–Clear CT; 9/22—CEA 2.4

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

lakeswim
Posts: 226
Joined: Sat Mar 31, 2018 9:37 am

Re: AST and ALT elevated?

Postby lakeswim » Wed Jan 02, 2019 1:13 pm

Hi Punky44....

AST near 160
ALT near 300

I had no symptoms (that I'm aware of) for these liver numbers. The normal pre-infusion blood draw showed the high levels. (They drew a second time that same morning to confirm. Levels were not exactly the same for each test, but still similarly high.) They had me wait another two weeks (for what was my infusion 5) and by then the levels were sig. down. (Still a bit higher than normal but not in the triple digits.)

My side effects (believe they were caused by Oxaly - not liver levels) - extreme cramping of hands and legs. I couldn't hold anything in my hands and couldn't walk well so very (temporarily) disabled. I'd have to look back in my notes but I believe they decided to 50% the Oxaly dose for the next round. Eventually, they dropped the Ox entirely - I think at round 7.

My tumor still apparently shrank a good deal - just from chemo! - so I don't regret dropping Ox at that late stage (per Onc's recommendation).

Punky -- I see your Mom is doing TNT? (I am too.) I hope she responds well. (I can't imagine doing FOLFOX at 68. Brutal.) In just a few moments, I am heading out to get my MR and CT scans (I finished radiation in late Nov) and meet with my surgeon tomorrow to determine next steps.
Female - RC dgns @ 49 y
Adenocarcinoma
10-11 cm from anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept 18
Capecetabine + Radiation - 28 sessions - Oct - Nov 18
Jan 19 - MRI & flex sig show tumor gone, Chest/ab CT no change
Feb 19 - MRI & flex sig show tumor gone
W&W (must travel)
May 19 - flex Sig - looks good
Sept 19 - Chest/ab CT no change, MRI no change, flex Sig looks good
Jan 19 - flex sig - looks good
*grateful*

Punky44
Posts: 446
Joined: Mon Oct 01, 2018 4:29 pm

Re: AST and ALT elevated?

Postby Punky44 » Wed Jan 02, 2019 1:54 pm

Thanks for the intel, lakeswim—wishing you awesome news at your scans!!

Yes, she’s doing neoadjuvant chemo—honestly knock on wood but so far she hasn’t had any side effects besides the occasional tingle when she’s cold.
Caregiver to my amazing mom (68 at dx)
10/1/18 DX with rectal cancer; CEA 17
T3N2M0
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
6/28/19 Reversal and port out
CEA 2.1; 1.9; 2.6; 2.8; 2.3; 2.4
Latest update: 6/20–Clear CT; 9/22—CEA 2.4

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

Punky44
Posts: 446
Joined: Mon Oct 01, 2018 4:29 pm

Re: AST and ALT elevated?

Postby Punky44 » Mon Jan 14, 2019 3:10 pm

Just an update that today her AST went down to 43 but her ALT went up to 62. They still think it’s ok to proceed to #6. Her platelets did dip down to 119 but they said as long as it’s above 90 they’re ok. Best news is CEA keeps dropping and is now 8.6!
Caregiver to my amazing mom (68 at dx)
10/1/18 DX with rectal cancer; CEA 17
T3N2M0
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
6/28/19 Reversal and port out
CEA 2.1; 1.9; 2.6; 2.8; 2.3; 2.4
Latest update: 6/20–Clear CT; 9/22—CEA 2.4

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

Gravelyguy
Posts: 323
Joined: Thu Jul 05, 2018 6:03 pm

Re: AST and ALT elevated?

Postby Gravelyguy » Mon Jan 14, 2019 3:45 pm

Great news for your mom Punky44! Keep that CEA dropping!

Lakeswim, I know it has been over a week since you posted on this thread but be mindful of dehydration. The worst, by far, I felt during chemo was when I got dehydrated. hands, arms, and calves all started cramping up. After IV fluids I felt much better. It was tough for me to get down enough room temp. fluids.

Dave
6/17 dx mRC t3n1m1 very low rectal tumor 2 liver Mets 1.3 cm and .9 cm

6/17 begin 4 rounds Folfox w/Vectibix
9/17 short course radiation
10/17 rectal and liver resection LAR with coloanal anastomosis (no rectum left)
11/17-3/18 8 rounds Folfox
6/18 still NED!! Takedown
8/28/18 still NED! CEA .8 new low for me
10/18/18 colonoscopy clear
12/12/18 clear scans, CEA .9 still NED!
6/11/19 clear scans CEA 1.0
12/19/19 clear scans CEA 1.0 still NED!
6/17/20 clear scans CEA 1.1 still NED!

User avatar
CRguy
Posts: 10234
Joined: Sun Feb 10, 2008 6:00 pm

Re: AST and ALT elevated?

Postby CRguy » Sat Jan 19, 2019 12:19 pm

Punky44 wrote:Just an update that today her AST went down to 43 but her ALT went up to 62. They still think it’s ok to proceed to #6. Her platelets did dip down to 119 but they said as long as it’s above 90 they’re ok. Best news is CEA keeps dropping and is now 8.6!


Best wishes for moving forward in '19 !!!

The docs will often be more interested in trends and ratios of lab values, rather than just a single number
i.e. an increase inside the normal range is not as concerning as the same proportional increase if you are above the normal range
( or in the case of platelets and WBC etc. a decrease :( )

Just the way chemo kicks our BUTTS sometimes.
Sounds like they are keeping a close eye on things.

Cheers
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
13 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

lakeswim
Posts: 226
Joined: Sat Mar 31, 2018 9:37 am

Re: AST and ALT elevated?

Postby lakeswim » Sat Jan 19, 2019 2:39 pm

Gravelyguy wrote:Great news for your mom Punky44! Keep that CEA dropping!

Lakeswim, I know it has been over a week since you posted on this thread but be mindful of dehydration. The worst, by far, I felt during chemo was when I got dehydrated. hands, arms, and calves all started cramping up. After IV fluids I felt much better. It was tough for me to get down enough room temp. fluids.

Dave


Hi Dave. Thanks. I’m glad to say my chemo was done last summer. I did get severe hand clawing and leg cramping (couldn’t hold things in my hands and walking was tough). The docs never mentioned dehydration as a factor. They told me cramping was caused by a severe reaction to Oxaly. Eventually, They decreased the Oxaly and ultimately stopped it after round 7 (if my memory serves me).
Female - RC dgns @ 49 y
Adenocarcinoma
10-11 cm from anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept 18
Capecetabine + Radiation - 28 sessions - Oct - Nov 18
Jan 19 - MRI & flex sig show tumor gone, Chest/ab CT no change
Feb 19 - MRI & flex sig show tumor gone
W&W (must travel)
May 19 - flex Sig - looks good
Sept 19 - Chest/ab CT no change, MRI no change, flex Sig looks good
Jan 19 - flex sig - looks good
*grateful*

Jannine
Posts: 189
Joined: Wed Jun 20, 2018 7:46 am
Location: Maryland, USA

Re: AST and ALT elevated?

Postby Jannine » Sat Jan 19, 2019 8:19 pm

I also had AST and ALT shoot up about midway through treatment, but they declined again soon after. I think my thread has details if you want to take a look!
DX: sigmoid colon cancer 5/2018. 48 F
laparoscopic sigmoid resection (24 cm removed); no stoma.
7.5cm adenocarcinoma -- mod. diff.
1 noncontiguous tumor deposit removed; 0/31 lymph nodes
T3 pN1c M0
5/18 before surgery, CEA 11.2
6/18 began FOLFOX
7/18: CEA 1.9; added neulasta post infusion
9/18: CEA 2.8
10/18: 25% chemo reduction
11/18: CEA 1.8
7/19 CT scan clear


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