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Carboplatin, Anti-Nausea Meds and Liver Enzymes

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made2b2gether View Drop Down
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    Posted: Mar 06 2015 at 4:31am
Hi,

So if you look up our case history, my wife is doing additional four cycles of AUC 6 Carboplatin, as we had some residual disease.

We have completed 2 of 4 cycles of Carboplatin. The first cycle there was some Nausea, but after the second cycle, the nausea was pretty bad for 2 days, so we went in for hydration and for steroid drip, with some anti-nausea medication primperan. We received further anti-nausea medications and my wife's nausea symptoms cleared up.

On February-27, about 11 days post my wife's 2nd chemo (February-9), her Liver enzymes had risen a lot - the AST was 129, and ALT was at 195.

We were told to postopone our next chemo by a few days and that we needed to wait till the liver enzymes decline, to the 50 range.

On Feb-27, we repeated the lab work, and the AST levels had declined to 40, and the ALT 70.

Today, March 6th, we took labs again, and my wife's AST declined further to 37, and the ALT is at 59. The Gtp level is at 173.

It's an improvement and our doctor said that the numbers were now normal and close to normal range and based on our labs on Chemo day on March 10th (a 7-day delay), we may continue with chemo.

The primary concern is if we should STOP / discontinue Chemo now, or if we should go further and risk liver toxicity.

There are good physicans that have told us to STOP. There are physicans that have said go ahead with caution. There are also doctors that have worked a lot with Carboplatin and say that liver enzymes are usually not a major problem with Carboplatin.

We have been told that liver toxicity can lead to long term bad effects on the liver, liver failure, and even death and that really scared us.

Our Liver numbers are more in line now, and we will have advise from good doctors, but at the end of the day, we have to decide if we ought to continue with the remaining two chemo doses.

Our question is - has any one seen such an increase in liver enzymes on Carboplatin - whereby numbers have gone UP 3x or 4x the normal levels?

What did you do? Did you continue with treatment???

We are not BRCA 1, 2 positive (no deletion), and we will never know if the additional Carboplatin will really help my wife, but we did it because we want to believe that we are doing every possible thing that we can do NOW. So, its tough to decide. And Carboplatin, chemo wise, is the only other known option left.

Has anyone had such an experience with Liver Enzymes. What did your doctor recommend and what did your personally do?

As per an article posted by Donna yesterday, Dr. Lisa Carey says -

​​“Based on this (TNT, U.K.) study, carboplatin is now on my list of first-line options for sporadic triple-negative breast cancer,” said Carey. “I generally chose between a taxane and platinum chemotherapy based on toxicities. Platinum chemotherapies result in less neuropathy compared to taxanes, but platinum-based regimens are also accompanied by more nausea and myelosuppression and can be harder on the kidneys compared to taxanes. Platinum-based chemotherapy is not a low-toxicity regimen, but rather, has different toxicities and may be more suitable for some patients.” In TNT, the docetaxel arm had a higher frequency of febrile neutropenia and neuropathy compared with the carboplatin arm (P <.01).

So, Carboplatin may be used even for cases that are sporadic, not just BRCA 1,2 positive, although it has been shown that Carboplatin is superior in BRCA 1, 2 cases. Docetaxel was superior for NON- BRCA patients, but the basal group was too small to pass total judgement on this. It is a fact that Carboplatin will be used more in Clincial Trials and for first line treatment in the near future.

At the end of the day, we will decide on what to do (Risk vs. any additional benefit, which we cannot calculate right now, as there is no tumor present). Just wanted to have your thoughts or experience if you've had any experience with liver Enzymes rising to this extent.

made2b2gether (do not know what to do !!! :(

Edited by made2b2gether - Mar 06 2015 at 4:36am
DX Jan06 `14. IDC TN 2.0cm. Grade 2. Neoadjuvant: Taxolx12,FECx4. Post Surgery LX- Tiny Micromets found in 4/17 removed LN- 6mm residual. Wide Radiation 25x. Carboplatin AUC 6 x 2, AUC 5 x 2
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Mar 06 2015 at 7:48am
I had problems with my liver enzymes when I was in the clinical trial with Iniparib, Carboplatin and Gemzar.  After my first cycle, they were so high it delayed treatment for 4 weeks.  I struggled the entire time with my levels going very high.  At one point it was 10 times higher than normal levels and I needed to be below 2.5 times to continue with treatment.  I tried Milk Thistle and believed it helped for me.  Also tried acupuncture.  I'm 4 years out from treatment and my liver enzyme levels are normal again and have no problems with liver functions.  I think chemo made my liver very sensitive, but don't know which drug might have caused it or the combination of all three?

Here's a link I started when I was going through treatment:


Donna
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote evia Quote  Post ReplyReply Direct Link To This Post Posted: Mar 06 2015 at 11:25am
Hello! we are from Madrid, Spain. In the hospital we moved to recieve the treatment all TNBC patients get carboplatin with docetaxel. We started in MD Anderson FEC 100 x4 and then taxol x 12 weekly. when we got the taxol number 5 in MDA we decided to move to another center as there was no way to get carboplatin in MDA, not as an adyuvate treatmente. Our new onc was confident we needed the carboplatin although its not in any protocol. so we ended up doing 4 x fec and 15 x taxol with 4 x carboplatine AUC6.

As to your question about liver enzyms, after carbo number 2 ALT was at about 60 and went up untill about a month after treatment AST stayed just a little bit high. Our onc has experience with carboplatin and said its normal given de agressive treatment and that there risk of damging the liver but given the diagnosis and prognosis its worth it. we listened to him and finally everything went well.

My personal opinion is that if possible try to finish the treatment.

hope it helps you.

good luck!



Edited by evia - Mar 06 2015 at 11:26am
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tripleneg-mom View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote tripleneg-mom Quote  Post ReplyReply Direct Link To This Post Posted: Mar 06 2015 at 11:51am
I had 2 cycles of Carbo/Gemzar.  It made my stomach feel pretty yuck and also made my liver #s go up.  They did decline enough by the next cycle, so the spike was not long lasting.  Chemo after surgery when NED is tricky because there is no tumor to monitor to see if how things are working.  Best of luck for the rest of treatment.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote made2b2gether Quote  Post ReplyReply Direct Link To This Post Posted: Mar 08 2015 at 11:50pm
Dear Donna,

Thanks as usual. You're so well informed and you're always quick to Reply.

Thanks Evia. Does your dear wife have the BRCA 1/2 deletion (or BRCA type functional issue? I ask because your doctor was pretty optimistic and insistent of the Carboplatin route of treatment, which as of late has proven to be more effective for people with a BRCA mutation (TNT Study in the U.K.). Carboplatin is also beneficial for sporadic TNBC (non-BRCA), however, and so is the current line of treatment with AC (FEC) and Taxol (or docetaxel or Abraxane). I guess it's the doctor that decides based on the profile of the cancer. But as not everything is so clear yet, if one can tolerate it, then why not hit it from all angles and hope for the best. It really is amazing that your wife really went out and threw everything at this cancer (lots of chemo) and i admire her bravery (and yours) and the ordeal that she went through. Yes, it can be very toxic and scary (the chemo), but I suppose you feel at peace that you did everything you can do in terms of available and recommended treatment options.
I wish you well my dear friends from Spain.

My wife's liver numbers have stabalised now.

The March 6th Labs were: Ast was at 37, Alt at 59. Gtp is 173. Her Haemoglobin was slightly low at 10.

I assume that by tomorrow, our scheduled date for Carboplatin infusion 3, the numbers will stabalise further.

Depending on how our conversation goes with our Oncologist we will go with AUC6 or AUC 5 tomorrow.

However, if my wife feels that she has done all that she can handle, then we'll stop the chemo.

Donna, I have ordered some Milk Thistle. If our doctor approves of it, we'll try taking some with our next infusion (if the delivery arrives on time).

Thank you for everything. This community really means a lot to us.

made2b2gether.

(PS- just for further information, my wife went ahead and did a Molecular profiling of 500+ genes and only one abberation was found called the CXCR1 biomarker which is not actionable (meaning there is no specific treatment for it for our current status and stage). Also, as our tumor sample was a residual sample, the analysis, although beneficial, may not be fully reflective of our diagnostic tumor.
They have a drug by a Company in Italy, DOMPE SPA, called Reparixin, however ALL trials are at a very early stage (1b) and I think it is only for very early disease, before chemo, or for metastatic disease, so this is NOT an option for us. But, all one can do is try and see what a test result gets us. :)

Also, as my wife is 29 now (Dx at 28), we did a 21 Multigene Breast - Ovarian Panel test and there were no findings of significance. There was an ATM gene detected, but it was a Varient of Uncertain Significance and so it is seen as benign and not a deletion. So basically we were tested for the following 21 genes in the Panel.

The test checked for the following genes:(BRCA1,BRCA2,CHEK2,PALB2,ATM,BRIP1,TP53,PTEN,
STK11,CDH1,NBN,BARD1,MLH1,MRE11,MSH2,MSH6,MUTYH,
PMS1,PMS2,RAD50,RAD51C)

We did not get any actionable result but the data could still be important on file. As all of you are, we are hopeful for more actionable treatments, a cure, easier treatment side effects, and for targeted therapy.

Please stay well ALL.

D&M





Edited by made2b2gether - Mar 09 2015 at 2:55am
DX Jan06 `14. IDC TN 2.0cm. Grade 2. Neoadjuvant: Taxolx12,FECx4. Post Surgery LX- Tiny Micromets found in 4/17 removed LN- 6mm residual. Wide Radiation 25x. Carboplatin AUC 6 x 2, AUC 5 x 2
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Post Options Post Options   Thanks (0) Thanks(0)   Quote JackiWalkr Quote  Post ReplyReply Direct Link To This Post Posted: Mar 27 2015 at 10:52am
I also had elevated liver enzymes all thru treatment.  I starting taking Turmeric with pepper and milk thistle and the end of treatment and it help tremendously.  They are safe to use during chemo ask your oncologist.  They help the liver purge toxins out.  I am still taking them to get my liver it tip top shape.  No side effects from them either.  Best of luck.
DX IDC TNBC 3/31/14 Age 46 Stage 2a, Grade 3, 2.1cm, 0 nodes, (4)Carbo(5)Taxol. AC DD 4 of 4. Lumpectomy 10/30/2014 NED. 33 Rads 2/12/15. BRCA 1/2 normal=negative
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Post Options Post Options   Thanks (0) Thanks(0)   Quote made2b2gether Quote  Post ReplyReply Direct Link To This Post Posted: Mar 27 2015 at 8:35pm
Dear jacki walkr :) thanks for writing.
My wife's liver enzymes has gone up by 10x.
We could not pinpoint the cause, and after getting
Varying physician opinions from stop now to go ahead
With dose reduction, we waited 6 weeks post the 2nd
Infusion and went with AUC5 instead of AUC6 for the 3rd Infusion.
Post the
3rd infusion, the liver enzymes did not rise and are stable
within a normal range (but on the high side), so the spike
Could have been due to a lot of nausea meds my wife took post
Infusion-2 with AUC6 carboplatin, due to a different pre-med
Routine (not sufficient and a non- long lasting type of med) for a lot of nausea and vomiting post dose 2.
She therefore ended up on hydration and taking several other pre-meds / post meds to prevent nausea post dose 2, but at another medical
Facility closer to home, so our prescribing oncologist could not pin point a cause effect.
So with this better pre-med regimen things have been better and we now
Have 1 dose left and then we complete treatment by April-13, 2015.
My wife did start on milk thistle. Turmeric is already a big part of our
Daily diet but i have capsules for my wife to take post treatment.
Appreciate the feedback Jacki.
I do not take names of meds as this is something that your Oncologist knows best.
My experience, ensure the responsibility is at One hospital and do not run around from
Hospital to hospital as the other medicines you are given or what you personally take can
Mask the actual cause effect of what is going on, and it becomes complicated for the Oncologist
To help you. Just our experience there.
Keep well!!! :)

Edited by made2b2gether - Mar 27 2015 at 8:45pm
DX Jan06 `14. IDC TN 2.0cm. Grade 2. Neoadjuvant: Taxolx12,FECx4. Post Surgery LX- Tiny Micromets found in 4/17 removed LN- 6mm residual. Wide Radiation 25x. Carboplatin AUC 6 x 2, AUC 5 x 2
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