Elevated Liver funtion tests---Avastin? Carbo? Gemzar?

• By blacksea_turtle
• Posted November 3, 2009 at 11:50 am
• Report post

Jeanie, I am on Carbo/Doxil/Avastin. I get the three of them every 4 weeks, and Avastin only every two weeks. I got my 3rd round on Friday.

So far no side effects, no problems with the liver either.

Are you getting them IV or IP? I know that if you get them IP then your liver function results can look bad.

May be you just need a break?

Best wishes, Elmira

• Reply

• By Jennali
• Posted November 3, 2009 at 1:54 pm
• Report post

Jeanie, I'm so sorry this latest worry has crept up.

If you are open to complementary medicine, you might consider asking your onc about using milk thistle. It helps detox the liver.

This is page from drweil.com. Even my very conventional gyn/onc thinks highly of Dr.Weil.

http://www.drweil.com/drw/u/id/QAA365823

I wish you well in solving this problem.

• Reply

• By kennebec
• Posted November 4, 2009 at 11:01 am
• Report post

I was on carbo/taxel and had elevated liver readings at one time during those sessions. However, if I remember correctly, I was on a high-dose antibiotic at the time and when I checked the side-effects for that, it showed a possibility of elevated liver readings.

Google the liver readings that you are concerned about and see if you can spy something about your regimen that may be causing that.

My readings went down to "norm" again, once I finished the antibiotic.

The moral to my story? Sometimes our "readings" can be caused by other things in our lives...other prescriptions, or overuse of some herb, etc. So don't panic...check all of it out as much as you can.

Jeanie, I think it is wise of you to discuss your concern about this with your Onc. He probably knows any prescrips you are using, but if you are using any "natural" substance, such as specific teas, herbs, supplements, be sure to give him that info as well.

Bless you.

• Reply

• By Sandylee
• Posted November 4, 2009 at 11:54 am
• Report post

Hi Jeanie,

I have been on Taxol-Sorafinib-Avastiin starting my 11th month at IU Cancer Center in Indianapolis, IN. I am reoccurant stage 4. I get this once a week for 3 wks. and then 1 week off. So far my liver counts are ok, but they keep a close eye on them with blood tests and CT-scans every 6 weeks. I think I'm having too many CT-scans! The Sorafinib causes mouth and throat sores really bad. I have infected nasal passages and sinises that bleed like crazy and Taxol.....well, I'm just use to it. I've had it for the past 6 years.

I hope you can find out more, I know it's hard. These days we are living on chemo but we don't know how much it's distroying other organs.

Take care and I hope you do well

Sandy

• Reply

• By jeaniet
• Posted November 4, 2009 at 2:23 pm
• Report post

thanks ladies--
Elmira, I am on IV. Never had IP.
Jennali----I am sure open to milk thistle as long as it doesn't interfere with chemo.
I just saw my local Oncologist (I see UC Davis Oncologist tomorrow) and he is still mystified about not only elevated liver tests, but also about how I have reacted in general to this chemo regime. He felt my liver, which is tender, but also my ribs are sore! He suggested it might be time to change drugs. But we'll see what UC Davis doc says.
I had liver tests run 10 days ago, the day I got Gemzar/Carbo. I had them run again today. They are more elevated today than 10 days ago, so maybe it isn't the Avastin since I haven't had Avastin since Oct 19th........!!!! AARGH.
I have a sneaking suspicion that nobody is going to know the answer to this.
Jeanie

• Reply

• By quacker
• Posted November 4, 2009 at 10:53 pm
• Report post

Did your CA 125 drop very rapidly since beginning chemo? There is a condition known as "tumor lysis syndrome". One of the ladies in my cancer support group had it. When too much cancer is killed at once, the liver cannot process the toxins released and becomes inflamed. The treatment is to cut back on chemo, drink lots of fluids and take milk thistle plus herbs to "drain" the liver. You'll need to consult a herbalist or naturopath as I don't remember what herbs were used.

• Reply

• By jeaniet
• Posted November 5, 2009 at 12:36 am
• Report post

Quacker----my CA 125 is not a valid monitor for me, although here is another oddity to ponder---my CA 125 was never above 21. However, my doc continues to run it anyway. After my July debulking it was 1,300! He said it was due to inflamation/surgery, not cancer. On Sept 30 it was 450, now it is 51.

But to throw a wrench into your idea, I had little (almost no) disease left after my debulking on July 30. So technically there should be no cancer left to kill except for a lymph node in my neck. But I find your idea quite interesting and it makes sense.
Jeanie

• Reply

• By Shamrock2009
• Posted November 5, 2009 at 4:22 pm
• Report post

Tumor Lysis Syndrome is rare in ovarian cancer and usually is an emergency problem :

"Characteristics that put a patient at risk for TLS are: tumor with a high proliferative rate (rapid division and growth); tumor with a high sensitivity to chemotherapy; and tumor of large size, i.e. “bulky disease”. Decreased kidney function and elevated lactate dehydrogenase (LDH) at baseline also increases risk. Most often, TLS is associated with the administration of induction chemotherapy, but it has been reported to occur with radiation therapy, corticosteroids, hormonal agents, biologics, monoclonal antibodies, intrathecal chemotherapy and chemo-embolization. TLS may even occur spontaneously, before the initiation of therapy.

Etiology

TLS is caused by the rapid destruction of tumor cells and the release of the contents of these cells into circulation. This release overwhelms the body's ability to maintain homeostasis, leading to hyperuricemia, hyperkalemia, hyperphosphotemia, hypocalcemia and uremia. Patients may demonstrate one, several, or all of these metabolic abnormalities. Let's review these abnormalities and why they happen.

Hyperuricemia (elevated uric acid) is the most common complication of TLS, and is caused by the release and breakdown of nucleic acids into uric acid. Uric acid is cleared by the kidneys, but large amounts can lead to crystal precipitation in the distal tubules, resulting in decreased renal function. Precipitation of uric acid crystals results in declining glomerular filtration, and ultimately, acute renal failure. This complication can be further exacerbated by dehydration, which is commonly seen in patients with TLS. Symptoms of hyperuricemia include: nausea, vomiting, diarrhea, and anorexia. Other problems that can increase risk of renal failure include: an abdominal tumor obstructing a ureter, preexisting renal insufficiency, or the use of nephrotoxic antibiotics (aminoglycosides). Uricemia can also result in a blockage of the ureter(s), causing hematuria, flank pain, oliguria, hypertension, fluid overload (CHF and edema), lethargy, and cloudy, sediment filled urine.

Hyperkalemia results from the kidney's inability to clear the massive amount of intracellular potassium that has been released due to cell breakdown. This complication can lead to life threatening arrhythmias and death. This can be further exacerbated by the renal failure caused by uricemia. Clinical signs include: nausea, vomiting, anorexia, and diarrhea. Muscular symptoms may include muscle weakness, cramps and parasthesias, and cardiac signs may include asystole, ventricular tachycardia or fibrillation, syncope and sudden death.

Hyperphosphatemia results from the rapid release of intracellular phosphorus. Of note, malignant cells contain about four times as much phosphorus as a normal cell. Phosphorous is also cleared by the kidneys, which quickly become overwhelmed and unable to maintain normal levels. Symptoms of this abnormality include: nausea, vomiting, diarrhea, lethargy and seizures. Hyperphosphotemia can also contribute to the development of renal failure by precipitating, along with calcium, in the renal tubules. As phosphate levels increase, they begin to combine with calcium, precipitating in the renal tubules (leading to kidney stones and failure) and the soft tissues (including muscle). This leads to a rapid drop in blood calcium levels, which may clinically present as agitation, tetany, severe muscle cramping and twitching, laryngospasm, and cardiac arrhythmias.

TLS can range from a few abnormal lab values to the other extreme, which include renal failure and cardiac disturbances. The key is identifying those patients at highest risk, instituting preventive measures, and performing close monitoring for symptoms and laboratory abnormalities in order to detect changes before they become life-threatening."

More info: http://www.oncolink.org/resources/article.cfm?c=16&s=46&ss=205&id=886

• Reply

Add to the discussion