Liver enzyme spike after adjuvant chemo

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Hooandtrue93
Posts: 18
Joined: Tue May 11, 2021 10:28 pm

Liver enzyme spike after adjuvant chemo

Postby Hooandtrue93 » Tue Oct 19, 2021 9:54 am

Has anyone experienced a spike in their live enzymes the first blood test after finishing adjuvant chemo?

My mom's ctdna cleared at the halfway point of her adjuvant and we get the results from her ctdna test next week for the draw she had today. But she also had metabolic panel done and her liver enzymes all spiked. Alkaline phosphatase is now around 390 and the other two live enzymes are around 100. They are withing the 5x the upper limit range but it was never that high before. Just having a lot of anxiety and hoping it's something like the liver still trying to function post chemo or something. She had her 12th cycle of chemo on September 21st.
28 year old, son of 62 year old mom
Stage 3B Duodenal Adenocarcinoma.
7/13 lymph nodes positive
02/22/2021: Whipple Surgery
04/08/2021: Port Surgery. CtDNA test sample taken (positive)
04/13/2021: Folfox-6 begins for 6 months
07/16/2021: ctDNA cleared. Continue with 3 more months of adjuvant chemo
09/21/2021: Last cycle of adjuvant chemotherapy.

rp1954
Posts: 1853
Joined: Mon Jun 13, 2011 1:13 am

Re: Liver enzyme spike after adjuvant chemo

Postby rp1954 » Tue Oct 19, 2021 12:17 pm

When were her previous, first and last metabolic panels done?
You might post the side by side comparisons.

It's a commonplace that many panels are trashed following 12 cycles of actual Folfox or Xelox at maximum tolerance dosing. Some panels can be permanently shifted or altered but most settle down over a year.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper chemo to almost nothing mid 2018, IV C-->2021. Now supplements

Hooandtrue93
Posts: 18
Joined: Tue May 11, 2021 10:28 pm

Re: Liver enzyme spike after adjuvant chemo

Postby Hooandtrue93 » Tue Oct 19, 2021 12:51 pm

Before chemo and before every chemo cycle her metabolic panel was done.

Her starting ASP was 140 and it was between 140-200, now 393

ALT was between 30-50, now 113

ALK was 20-50, now 116

I did read that flu shot can cause a spike in liver enzymes and she had her flu shot last week (the case reports i found saw spikes very similar to my mom's).

Bilirubin is normal. We stopped all supplements today outside magnesium and potassium. No pain or symptoms whatsoever.
28 year old, son of 62 year old mom
Stage 3B Duodenal Adenocarcinoma.
7/13 lymph nodes positive
02/22/2021: Whipple Surgery
04/08/2021: Port Surgery. CtDNA test sample taken (positive)
04/13/2021: Folfox-6 begins for 6 months
07/16/2021: ctDNA cleared. Continue with 3 more months of adjuvant chemo
09/21/2021: Last cycle of adjuvant chemotherapy.

User avatar
beach sunrise
Posts: 1034
Joined: Thu Mar 05, 2020 7:14 pm

Re: Liver enzyme spike after adjuvant chemo

Postby beach sunrise » Tue Oct 19, 2021 9:40 pm

Have you researched chelating the toxins out of her system?
My levels kept climbing and climbing until I said NO more. Then began detoxing my liver/body and got levels back to low normal.
ND tells me today that AST/ALT levels should really be below 24, hmmm. He says the higher upper limit is to high and BS to say liver is healthy above 24 level. Idk! Going to research this some more.
8/19 RC CEA 82.6 T3N0M0
5FU/rad 6 wk
IVC 75g 1 1/2 wks before surgery. Continue 2x a week
Surg 1/20 -margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24 post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
CEA
7/20 11.1 8.8
8/20 7.8
9/20 8.8, 9, 8.6
10/20 8.1
11/20 8s
12/20 8s-9s
ADAPT++++ chrono
CEA
10/23/22 26.x
12/23/22 22.x
2023
1/5 17.1
1/20 15.9
3/30 14.9
6/12 13.3
8/1 2.1
Nodule RML SUV 1.3 5mm
Rolles 3 of 4 lung nodules cancer
KRAS
Chem-sens test failed Not enough ca cells to test

Rock_Robster
Posts: 1027
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Liver enzyme spike after adjuvant chemo

Postby Rock_Robster » Thu Oct 21, 2021 9:22 am

Not saying it’s ideal, but several of my liver enzyme markers got well into the 800s after FOLFOX. It takes a beating but it’s a helluva tough organ, and recovered fine. My onc said he mainly bases it on whether you’re having any symptoms of liver injury, and that on blood work alone he’d start with worry if we got over 1,000 on anything. The “normal” ranges really don’t have chemotherapy in mind!

No issues with the liver these days (13 cycles and 2 resections).

Good luck,
Rob
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial

MadMed
Posts: 216
Joined: Sun May 02, 2021 5:52 pm
Location: Massachusetts

Re: Liver enzyme spike after adjuvant chemo

Postby MadMed » Thu Oct 21, 2021 1:06 pm

Same as Rock_Robester. My AST and ALT went up during but after chemo (3 weeks after) they were back to normal. Now going through radiation my CBC is outta whack, lymphocytes, MCHC and RDW are out of control but the oncologist says that's expected.
52M DX: RC lower rectum, guessing now 2cm from AV 4/27/2021
T3N0M0 adenocarcinoma with signet ring cell features
Tumor size 30mm
Tumor grade: G3
Baseline CEA 1.0
MSI status: MSS pMMR
Started Folfox 5/12/2021
Switched to FOLFIRINOX from session 2. 8 rounds total.
CT+MRI tumor contained shrunk 80%, no spread to other organs.
CRT started xeloda + 28 days Radiation 9/27-11/04
NED as of 4/06 CT/MRI/sigmoidoscopy
On W&W 04/06/2022

Hooandtrue93
Posts: 18
Joined: Tue May 11, 2021 10:28 pm

Re: Liver enzyme spike after adjuvant chemo

Postby Hooandtrue93 » Mon Oct 25, 2021 10:00 am

Mom was retested.

ALP: 513
AST: 163
ALT: 159

Bilirubin: .09

Everything else is normal. No symptoms at all for mom. Im just worried because they are increasing from last week. Still within the X5 of the upper limit/technically a mild elevation but still worried.

She is a month out from chemo now. Taking deep breathes and waiting for next steps from the oncologist/see if he orders an ultrasound.
28 year old, son of 62 year old mom
Stage 3B Duodenal Adenocarcinoma.
7/13 lymph nodes positive
02/22/2021: Whipple Surgery
04/08/2021: Port Surgery. CtDNA test sample taken (positive)
04/13/2021: Folfox-6 begins for 6 months
07/16/2021: ctDNA cleared. Continue with 3 more months of adjuvant chemo
09/21/2021: Last cycle of adjuvant chemotherapy.

User avatar
CRguy
Posts: 10473
Joined: Sun Feb 10, 2008 6:00 pm

Re: Liver enzyme spike after adjuvant chemo

Postby CRguy » Wed Oct 27, 2021 2:33 pm

Just a quick note for you here my friend, and also for other newer members :

When posting specific lab values, it does help other readers here when you also give the normal lab ranges for your own testing lab.
The 5X increase is a good qualitative rule of thumb for the Docs to use ... BUTT ...
there are different testing methodologies / protocols in the various areas / countries our members come from
and seeing where the values are within your local, normal reference range is important for the discussion.

Cheers and best wishes to you and your Mom
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
17 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

Hooandtrue93
Posts: 18
Joined: Tue May 11, 2021 10:28 pm

Re: Liver enzyme spike after adjuvant chemo

Postby Hooandtrue93 » Mon Nov 01, 2021 7:55 pm

The cancer has spread.

At least 6 tumors in the liver, the largest being 4.4cm
enlargened medistinal lymph nodes.
one 3cm tumor in the tumor bed.

Once she is stabilized and out of the hospital they will start her on folfiri avastin and run ngs testing.

Heartbroken, in shock, but also hopeful and praying for a miracle.
28 year old, son of 62 year old mom
Stage 3B Duodenal Adenocarcinoma.
7/13 lymph nodes positive
02/22/2021: Whipple Surgery
04/08/2021: Port Surgery. CtDNA test sample taken (positive)
04/13/2021: Folfox-6 begins for 6 months
07/16/2021: ctDNA cleared. Continue with 3 more months of adjuvant chemo
09/21/2021: Last cycle of adjuvant chemotherapy.

claudine
Posts: 809
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Liver enzyme spike after adjuvant chemo

Postby claudine » Fri Nov 05, 2021 10:30 am

I understand your concerns. My husband also failed adjuvant chemo; but the second line, Folfiri/Avastin, worked very well. Stay hopeful!
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A, no primary

Tumors: L4 04/18; left adrenal gland & small lung nodules 03/19
rectum 02/22 (pT3 pN0 stage 2A); L3 09/22

Surgeries: intestinal resect. 05/18 (no cancer - Crohn's); adrenalectomy 02/20
L3-L4-L5 fusion and corpectomy 05/20; LAR 04/22; ileo reversal 09/22
L2-L3 fusion and corpectomy 09/22

Treatments: EBRT 04/18; SBRT 02/19; Failed adjuvant Xelox ; Folfiri/Avastin 03/19 - 01/20
adjuvant chemorad (Xeloda) 06/22; SBRT 11/22; Xeloda/Avastin since 01/24

Siti
Posts: 269
Joined: Thu Aug 01, 2019 10:58 am

Re: Liver enzyme spike after adjuvant chemo

Postby Siti » Fri Nov 05, 2021 4:08 pm

My husband’s liver enzymes never recovered. Many of the readings are still in the red — he’s currently on maintenance chemo.
DH (54) DX on 5/7/19
Sigmoid|G3|LN:30/31|MSS|WT KRAS, NRAS, BRAF
7/19 PET distant LN para-aorta neck hip (0.5-1.5cm)
7/19 Lap resection
26/8 to 20/12/19 CAPEOX+Bev 7x
6/11/19 CT 3 cycle LN shrunk
1/20 Cap+Bev
4/20 TS-1+Bev due to bad HFS
NED 4 years
8/23 PET recurrence chest LN growing since Feb. CEA May(4.5>5.1>5.9)
9/23 Stopped Bev, CEA Sept(8.7) Radio 17x
11/23 PET 1+ supraclavicular LN, CEA (3.4>2.5)
12/23 Lymphadenectomy
1/24 Narrow margins, 1/5 +LN, 1.4cm +tissue, TMB (19)


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