Infection and markers

[IM64]

My wife had a flu last 2 weeks. COVID Test is negative, probably seasonal flu/viral infection with cough, runny nose, T around 37.2 - 37.5C. Yesterday we had blood work, and all her liver (ALT, ALP, GGT, LD) and cancer (CEA, CA19-9, CA 125) markers raised up. That is the first time her markers jumped from we started chemo 4 month ago.

Does anyone have a similar experience with infection and changes in cancer/liver blood markers? We want to hope that is not because Folfox is done. Tomorrow we have a meeting with oncologist, and planned ask him to switch Folfox to Xeloda. But in this situation, when the markers are growing, we started to doubt if that is the right decision.

Any advice and experience are very welcome.
Thank you

[I_will_fight]

Not quite the same experience but I undestand CEA is filtered by the liver, so any condition which is capable of stressing your wife`s liver would raise here liver enzymes and also the CEA levels.

CA-125 is known to fluctuate in different phases of women's cycle.

So it could be nothing but I guess it could be something as well.

Could you request to get the test repeated soon? When I was on chemo I had my levels checked every three weeks.

Also you may want to ask about ctDNA testing.

Is HAI pump an option for your wife (it seems to be more effective than systemic chemo for liver mets, but I understand few hospitals implant it)

Good luck!

[Nor Cal]

Not much to offer, but my liver enzymes do rise when I'm sick and/or dehydrated. My CEA has always bounced all over the place, so difficult to identify any correlation with sickness. I guess a lot would depend on the scale of the rise. I can see a 50% increase or decrease in CEAs taken a week apart (I'm consistently in the 3-4.5 range currently) whereas my liver enzyme elevations are more moderate when they increase due to illness/dehydration.

[IM64]

Could you request to get the test repeated soon? When I was on chemo I had my levels checked every three weeks.

Oncologist order blood test every two weeks before next infusion cycle. And we do one more advanced test privately also every 2 weeks.

Is HAI pump an option for your wife (it seems to be more effective than systemic chemo for liver mets, but I understand few hospitals implant it)

Thanks for advice. Unfortunately we are not candidate for HAI pamp due to lung mets..

[IM64]

Not much to offer, but my liver enzymes do rise when I'm sick and/or dehydrated. My CEA has always bounced all over the place, so difficult to identify any correlation with sickness. I guess a lot would depend on the scale of the rise. I can see a 50% increase or decrease in CEAs taken a week apart (I'm consistently in the 3-4.5 range currently) whereas my liver enzyme elevations are more moderate when they increase due to illness/dehydration.

Thanks for sharing your experience. Our CEA raised from 498 to 586 - both numbers are huge.

[beach sunrise]

I had the Faucci whatever the week of Thanksgiving 2022. Had bloodwork a week before I got sick and things looked good. Then 2 weeks after being sick bloodwork showed CEA lower but vitaminD levels were half of what they were before, liver markers were high including AFP. Liver markers were back to normal after sickness with second bloodwork in Dec. Also my immuno know test had fallen. My body used up some important vitamins/minerals during sickness. Still trying to build them up.

[Rock_Robster]

Not much to offer, but my liver enzymes do rise when I'm sick and/or dehydrated. My CEA has always bounced all over the place, so difficult to identify any correlation with sickness. I guess a lot would depend on the scale of the rise. I can see a 50% increase or decrease in CEAs taken a week apart (I'm consistently in the 3-4.5 range currently) whereas my liver enzyme elevations are more moderate when they increase due to illness/dehydration.

Thanks for sharing your experience. Our CEA raised from 498 to 586 - both numbers are huge.

Yes and no… of course trend is more important than absolute. It’s a jump for sure, but the highest I’ve seen is >80,000. Some nomograms use >200 as a “high CEA” cancer cutoff, vs a “low CEA” cancer (as opposed to <3-5 being “normal”).

[IM64]

Thanks everyone for your thoughts and input. Met oncologist today - he doesn't think CEA rise is due to the infection. Probably first line with Folfox is done (just 8 cycles!). MRI will be next week to confirm and continue with Folfox for now. If progress is confirmed, we will probably switch to Folfiri.

[Claudine]

For what it’s worth, my husband failed Xelox but had great success with Folfiri

[IM64]

New line is new hope for sure. Thanks for add positive and its really great the folfiri does good job for your husband!

With our mutations we don't have a lot of options, so each working drug is very important. We were going to switch to oral Xeloda mono (+ IV vit C and other +++) - to try to save the immune system as much as possible. But with possible growing disease it doesn't looks a good idea. Waiting MRI next week to see the picture. First time met the CEA jump, really worry

[IM64]

Short update after new CT and blood work.
1. Liver markers are going down. Not as low as the were before infection, but trend is down. So looks like they were affected by infection.
2. CEA continues to grow (from 581 to 651). Doesn't appear to be related to infection.
3. CT doesn't show any changes (best news for us today)
4. CBC blood markers (WBC, RBC, Hgb, Neutrophils) dropped. We think it's chemo result.

Looks like Folfox isn't as helpful as it was before. It still prevent to tumor progression, but CEA start growing and blood markers start dropping.
My question is - would you continue with same regimen in that situation, or it's time to change it? Our follow up meeting with onc scheduled on Friday, and I just want to prepare to it and have plan B (or may be C too).

Thanks

[Rock_Robster]

Good news about the CT! But yes the other results are a bit confounding!

How many FOLFOX cycles so far? How’s the neuropathy going?

What was covered in the CT? Assume it was with/without contrast? And compared an equivalent CT?

[IM64]

Actually she has no any neuropathy symptoms, and overall she doesn't feel bad. May be due to IV vit C + a lot of supplements.
It was 9th Folfox cycle. After the 8th, the markers began to grow, onc ordered CT and continued folfox.

CT was last Friday for all - chest, abdomen and pelvis. Purpose of CT order indicated as - Rule out progression. CT was both - without contrast first, and with contrast after, and yes, it was compared with same previous CTs. Impression is - "Multifocal bilobar hepatic metastases are unchanged". Onc also ordered MRI for liver only. It was yesterday, and we don't have result yet.

[rp1954]

Realities
You're not ready at this moment to go to ADAPT ++++ which is what your wife's degree of load would more likely respond to.
Historically, it's hard to say what some of Lin's mCRC patients' biggest successes (complete responses) were really like in terms of huge metastatic load vs "merely" some chemo hardened multisite spread when starting on ADAPT alone.
(Xeloda vs) ADAPT vs ADAPT ++ vs ADAPT ++++ are going to have different yield curves.

Those of us here with some degree of daily chemo (ADAPT, UFT-LV) experience and +s built up to it experimently, mostly perioperatively with reduced or lower loads.
To me, ADAPT and ADAPT++ with a high load, are about trying stop spread and maybe slowing growth or dint some mets.
Salvage surgeries are the likely backup requirement for large CEA drop on ADAPT, complete and partial responses on chemo being % successes.
With my wife, one notable immunochemo action (2-3 cm liver objects on CT) is hard to separate between improved activity due to surgically reduced tumor burden, and improved immuno chemistry, I credit both.

Our limited experience base revolves around people heading into surgery, after surgery, or limited tumor burden.
Our ++ experience starts with my wife getting ahead before her first surgery, before chemo, with a huge necrosis and/or immune reaction, probably starting between day1 and day14 after dx. Then some months on chemo trials beyond the local dr's direct experience levels but spread over 15 months of research and preparation. Of course that compresses greatly with experience and good support.

I had hoped one high burden patient would make the switch from Folfoxiri after a substantial marker reduction but they were delayed, stayed too long on cyclic chemo, and burnt out on their CBC. Std oncology often drives to grade 3 or grade 4 side effects before backing off, kind of a scorched earth affair. Whereas home brewed between several dr's you need to fix it or back off between grade 1 or 2 side effects.
----
First, your std oncologist is not ready for ADAPT ++++ at all. And may never be.
If you could break the technical details down to him, he might be stunned silent, laugh, explode or some combination.
It took several years for our most interested oncologist to realize he needed to pay attention.
Kind of like Oumuamua, Inter Stellar object 1, moving fast and almost out of the solar system when finally noticed.
Some patients just get whatever scrip(s) possible for insurance and supply, then mostly work with other doctors.
In a crazy world, continuous supplies can be a big deal over several years if you don't prepare.
You need Drs who will support you for complications not even chemo based and help with large scrips, maybe whoever supports IVC.
An example would be ready to go on chemo with substantial COVID or vaccine after effects.
In western Canada, there were patients who had a clinic that combined Folfiri with IV vitamin C and K infusions. A clinic like that might be a partial support for an ADAPT patient (I don't know).

Second, you're not ready yet. I'd say you might hustle to ADAPT ++/+++ with some improved skills and drs right now.
You need your dr's, supplies, labs, your DIY efforts lined up and going to start at ADAPT+++ and then carefully transition into ADAPT++++, a high dose(!) chronomodulated version in a technical manner.

There is also some degree of transition between Folfox/Folfiri and xeloda because of excess leucovorin effects for several weeks.

If you continue your supplement and complementary program for Folfiri, I might call that Folfiri++, it's not continuous and not chronomodulated.
Folfiri++ should have notable advantages over Folfiri and some CEA drops but not quite the same benefits as ADAPT with +s.
Potentially the biggest benefit might be being able to chain incomplete, noncurative or locally curative cancer surgeries together in a curative manner.

[rp1954]

Actually she has no any neuropathy symptoms, and overall she doesn't feel bad. May be due to IV vit C + a lot of supplements.
It was 9th Folfox cycle. After the 8th, the markers began to grow, onc ordered CT and continued folfox.

Glutamine may be a factor reducing oxi- related neuropathies. A number of papers on search engines.