Infection and markers

Please feel free to read, share your thoughts, your stories and connect with others!
IM64
Posts: 90
Joined: Wed Nov 02, 2022 5:51 pm

Infection and markers

Postby IM64 » Thu Feb 16, 2023 7:56 am

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
Husband of DX 10/2022 (50 yo), Stage IV, MSS, KRAS G12A, PIK3CA, G545L
Multiple bilateral Lung mets/Extensive bilobar Liver mets, CEA 4163
10/2022 Colostomy, Biliary drain, FOLFOX (+Avastin 4 rounds)
1/2023 Biliary drain removed, CEA 498
3/2023 FOLFOX failed after 9 rounds total, CEA raised to 651, started FOLFIRI w/o Avastin

I_will_fight
Posts: 148
Joined: Mon Jun 29, 2020 3:38 pm

Re: Infection and markers

Postby I_will_fight » Thu Feb 16, 2023 12:47 pm

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!
46 yo male Spain
06/2020 - 6cm T3N0M0 CC splenic flex
3 and 4 mm lung ground glass
lymp 0/37
dMMR MSH6
KRAS mt G13D
V/LNI absent
PNI present
07/20 - hemicol surg, optimistic surgeon.
11/20 - 4 x CAPOX completed.
12/20 - Clear colonoscopy
02/21 - MRI liver lesion unchanged.
11/21 - Clear CT
02/22- Colonoscopy: Sessil polyp 3mm
05/22- Clear CT
06/22- Negative Signatera
12/22- Negative Signatera
01/23- Clear CT
07/23- Clear CT, normal markers.
09/23 - Negative Signatera
01/24 - Clear CT

Nor Cal
Posts: 89
Joined: Sun Dec 06, 2020 8:18 pm

Re: Infection and markers

Postby Nor Cal » Thu Feb 16, 2023 3:11 pm

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.
Dx June 2020, stage IV, w liver mets in both lobes. M, age 50. Right-sided colon tumor. CEA 120.
BRAF+ TMB 5% MSS TDL1-1%
July 2020 - Present: 55 cycles chemo (All the various 5-FU regimens)
December 2020 - February 2021 Y90 Radioembolization, Chemoembolization x2

IM64
Posts: 90
Joined: Wed Nov 02, 2022 5:51 pm

Re: Infection and markers

Postby IM64 » Thu Feb 16, 2023 5:30 pm

I_will_fight wrote: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.

I_will_fight wrote: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..
Husband of DX 10/2022 (50 yo), Stage IV, MSS, KRAS G12A, PIK3CA, G545L
Multiple bilateral Lung mets/Extensive bilobar Liver mets, CEA 4163
10/2022 Colostomy, Biliary drain, FOLFOX (+Avastin 4 rounds)
1/2023 Biliary drain removed, CEA 498
3/2023 FOLFOX failed after 9 rounds total, CEA raised to 651, started FOLFIRI w/o Avastin

IM64
Posts: 90
Joined: Wed Nov 02, 2022 5:51 pm

Re: Infection and markers

Postby IM64 » Thu Feb 16, 2023 5:49 pm

Nor Cal wrote: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.
Husband of DX 10/2022 (50 yo), Stage IV, MSS, KRAS G12A, PIK3CA, G545L
Multiple bilateral Lung mets/Extensive bilobar Liver mets, CEA 4163
10/2022 Colostomy, Biliary drain, FOLFOX (+Avastin 4 rounds)
1/2023 Biliary drain removed, CEA 498
3/2023 FOLFOX failed after 9 rounds total, CEA raised to 651, started FOLFIRI w/o Avastin

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

Re: Infection and markers

Postby beach sunrise » Thu Feb 16, 2023 10:47 pm

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.
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: Infection and markers

Postby Rock_Robster » Thu Feb 16, 2023 11:06 pm

IM64 wrote:
Nor Cal wrote: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”).
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

IM64
Posts: 90
Joined: Wed Nov 02, 2022 5:51 pm

Re: Infection and markers

Postby IM64 » Fri Feb 17, 2023 2:56 pm

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.
Husband of DX 10/2022 (50 yo), Stage IV, MSS, KRAS G12A, PIK3CA, G545L
Multiple bilateral Lung mets/Extensive bilobar Liver mets, CEA 4163
10/2022 Colostomy, Biliary drain, FOLFOX (+Avastin 4 rounds)
1/2023 Biliary drain removed, CEA 498
3/2023 FOLFOX failed after 9 rounds total, CEA raised to 651, started FOLFIRI w/o Avastin

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

Re: Infection and markers

Postby claudine » Sat Feb 18, 2023 11:37 am

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

IM64
Posts: 90
Joined: Wed Nov 02, 2022 5:51 pm

Re: Infection and markers

Postby IM64 » Sat Feb 18, 2023 5:20 pm

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
Husband of DX 10/2022 (50 yo), Stage IV, MSS, KRAS G12A, PIK3CA, G545L
Multiple bilateral Lung mets/Extensive bilobar Liver mets, CEA 4163
10/2022 Colostomy, Biliary drain, FOLFOX (+Avastin 4 rounds)
1/2023 Biliary drain removed, CEA 498
3/2023 FOLFOX failed after 9 rounds total, CEA raised to 651, started FOLFIRI w/o Avastin

IM64
Posts: 90
Joined: Wed Nov 02, 2022 5:51 pm

Re: Infection and markers

Postby IM64 » Wed Mar 01, 2023 6:50 pm

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
Husband of DX 10/2022 (50 yo), Stage IV, MSS, KRAS G12A, PIK3CA, G545L
Multiple bilateral Lung mets/Extensive bilobar Liver mets, CEA 4163
10/2022 Colostomy, Biliary drain, FOLFOX (+Avastin 4 rounds)
1/2023 Biliary drain removed, CEA 498
3/2023 FOLFOX failed after 9 rounds total, CEA raised to 651, started FOLFIRI w/o Avastin

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

Re: Infection and markers

Postby Rock_Robster » Thu Mar 02, 2023 4:03 am

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?
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

IM64
Posts: 90
Joined: Wed Nov 02, 2022 5:51 pm

Re: Infection and markers

Postby IM64 » Thu Mar 02, 2023 8:13 am

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.
Husband of DX 10/2022 (50 yo), Stage IV, MSS, KRAS G12A, PIK3CA, G545L
Multiple bilateral Lung mets/Extensive bilobar Liver mets, CEA 4163
10/2022 Colostomy, Biliary drain, FOLFOX (+Avastin 4 rounds)
1/2023 Biliary drain removed, CEA 498
3/2023 FOLFOX failed after 9 rounds total, CEA raised to 651, started FOLFIRI w/o Avastin

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

Realities

Postby rp1954 » Thu Mar 02, 2023 1:32 pm

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.
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

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

Re: Infection and markers

Postby rp1954 » Thu Mar 02, 2023 5:33 pm

IM64 wrote: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.
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


Return to “Colon Talk - Colon cancer (colorectal cancer) support forum”



Who is online

Users browsing this forum: No registered users and 123 guests