Liver Issues with Paclitaxel (Taxol)?

oldbeauty

My second chemo session was canceled last week after my blood work showed elevated liver function values (AST and ALT).  Blood test for hepatitis is negative and ultrasound of the liver is negative for mestastasis (in chemo for metastasis to lungs after 5 years in remission with high-dose progesterone).  This week's blood work shows AST and ALT levels still going up.  Gyn oncologist is mystified but has research suggesting it is the Taxol that is responsible (Taxol is metabolized by the liver).  His plan is to withhold Taxol from chemo 2 tomorrow and then for chemo 3 administer it to see what happens (assuming that the AST and ALT levels begin to revert more to the low or acceptable-elevated levels so that the experiment can be done).  Does anyone have any experience or knowledge about Taxol, or its equivalents, causing liver damage?  Apparently, there is no alternative to Taxol because all of its equivalents are also metabolized by the liver, and it may be that my liver just cannot handle it.  Which raises the question why is Taxol paired with Carboplatin in the first place.  My doc says Carboplatin is the more important of the two.  Thanks for any feedback or direction to research sources.  Oldbeauty

MAbound

Hi

Beth, I'm so sorry that you've had this recurrence and ran into this difficulty, especially after reaching that so-called magic 5 year NED mark! So unfair! My understanding is that Taxol can have adverse effects on the liver of about 20% of those who recieve it. Liver side effects hit EZLiving pretty hard when she had frontline. I guess the odds are favorable enough that the doctors give it a shot anyway. Are they keeping you on the progesterone therapy or has that stopped now because of the recurrence? Did you recieve Taxol previously for frontline? Are you taking Metformin at all if you're still on the progesterone therapy? It can help induce or recover PR receptor sensitivity. I'm glad your sensitivity to Taxol wasn't catastrophic when it occurred and that chemo going forward will be gentle, but effective for you. Hang in there and keep us updated when you're up to it. We're here for you should you need us.

Pat

oldbeauty

MAbound said:

Hi

Beth, I'm so sorry that you've had this recurrence and ran into this difficulty, especially after reaching that so-called magic 5 year NED mark! So unfair! My understanding is that Taxol can have adverse effects on the liver of about 20% of those who recieve it. Liver side effects hit EZLiving pretty hard when she had frontline. I guess the odds are favorable enough that the doctors give it a shot anyway. Are they keeping you on the progesterone therapy or has that stopped now because of the recurrence? Did you recieve Taxol previously for frontline? Are you taking Metformin at all if you're still on the progesterone therapy? It can help induce or recover PR receptor sensitivity. I'm glad your sensitivity to Taxol wasn't catastrophic when it occurred and that chemo going forward will be gentle, but effective for you. Hang in there and keep us updated when you're up to it. We're here for you should you need us.

Pat

Thanks for the info

Pat, thanks for your response. I will ask my doctor about Metformin; he is familiar with studies about rebooting progesterone receptor status.  I am off the progesterone and taking hydrocortisone instead, for its ability to substitute for cortisol that my adrenal no longer produces.  This is my first experience with chemo.  Previously, I had surgery and external radiation.  Thanks for your good wishes.  Oldbeauty

Kvdyson

Oldbeauty, I understand your

Oldbeauty, I understand your concern. My ALT went very high during chemo - maxing out at 87 IU/L when the normal range is between 0 and 32 IU/L. I referred myself to a gastro/liver specialist who could find nothing wrong with my liver and chalked it up to the chemo. Before chemo it was 26 IU/L. I haven't had any labs since the end of treatment so not sure what the number is now but I'm hoping it's back within normal range. Hopefully your numbers will also go back to normal once treatments are over. Kim

oldbeauty

Kvdyson said:

Oldbeauty, I understand your

Oldbeauty, I understand your concern. My ALT went very high during chemo - maxing out at 87 IU/L when the normal range is between 0 and 32 IU/L. I referred myself to a gastro/liver specialist who could find nothing wrong with my liver and chalked it up to the chemo. Before chemo it was 26 IU/L. I haven't had any labs since the end of treatment so not sure what the number is now but I'm hoping it's back within normal range. Hopefully your numbers will also go back to normal once treatments are over. Kim

Going to look for a liver specialist as a precaution

Kim, thanks for your response. My ALT went from 15 IU/L two days before chemo one to 142 two days before aborted chemo two to 222 two days before actual chemo two, which proceeded with Taxol wittheld.  My provider lists normal range as 14 to 54 IU/L.  My AST went from 16 to 45 to 76 on the same dates with normal range listed as 15 to 41 IU/L.  Only these two liver enzymes are misbehaving.  Each of them is involved in metabolizing protein.  The only info I found that was of interest is the fact that Colace, which I have been taking 2-3 tablets per day since December 18, also is metabolized by the liver (like Taxol).  The onco nurse did not know that and told me to stop Colace and use MiraLax instead.  I will have new blood work on Feb. 7. I eat a healthy diet, I do not drink alcohol and exercise every day.  I do not take drugs and I don't have hepatitis.  So this is a mystery.  The infusion nurse told me that she had had a few ladies with liver enzyme issues and so while it's rare, it does happen.  If my levels don't go down, I am going to see a liver specialist and will try to make a provisional appointment now.  My PA told me I should not worry about acute liver disease/failure.  To just go with the flow and wait and see. Thanks again for your input.  Oldbeauty

Nellasing

Nothing to add ...

just want you to know I'll be thinking about you and sending you good wishes- sounds like you are doing everything you can do.  (((HUGS)))

oldbeauty

Nellasing said:

Nothing to add ...

just want you to know I'll be thinking about you and sending you good wishes- sounds like you are doing everything you can do.  (((HUGS)))

Good wishes are welcome

Nellasing, I appreciate the kind words.  I have an appointment with a liver specialist and sent an email to my oncologist telling him why I am doing this and expressing confidence in his approach. I am a believer in information and these rising levels are worrying me.  I was fortunate to be an outlier in the five years of remission I got from hormone therapy.  But I don't fancy being an outlier on very rare side effects.  I would like to have the "full monty" standard treatment.  We'll see.  Oldbeauty

takingcontrol58

Liver Enzymes

Old Beauty,

Your high liver enzymes could be tied to a few things. Key one is non alcoholic fatty liver, high levels of iron in the blood,
high levels of medications (liver processes all medications- chemo included).
All dead cancer cells also go through the liver. That is why it is important to detox your liver while you are getting chemo. 
You can drink a glass of water with the juice of 1/2 lemon each morning. It detoxifies your liver and keeps your body alkaline
(cancer thrives in an acidic body).

I would suggest you ask your doctor to order a liver ultrasound. It can show if you have a fatty liver.

Glucose is made in the liver and the liver also stores iron.  I would suggest you get your ferritin levels tested (measures
iron stores). My iron levels were very high when my cancer metastasized (to the liver, spleen, outer rectum, lung nodules,
nodule on outer colon).

I would definitely ask your doctor about getting on metformin.  That drug got me to complete remission with 34cm of metastatic
tumors, which showed up 2 months after surgery,before I even started chemo. That was Jan 2015.  I have been in complete
remission since August 2015. Remain on metformin and take 44 supplements each day. Also radically changed my diet and lost
30 pounds. Metformin has been known to have many anti-cancer properties since 2005.  It is well known for diabetes and
insulin resistance, two risk factors for endometrial cancer.  The drug saved my live.

I don't know if you work with a naturopath, but there are certain supplements that are very good for liver support.
I also take some key supplements for liver support.

Hope this is helpful.
Takingcontrol 58

 

 

oldbeauty

takingcontrol58 said:

Liver Enzymes

Old Beauty,

Your high liver enzymes could be tied to a few things. Key one is non alcoholic fatty liver, high levels of iron in the blood,
high levels of medications (liver processes all medications- chemo included).
All dead cancer cells also go through the liver. That is why it is important to detox your liver while you are getting chemo. 
You can drink a glass of water with the juice of 1/2 lemon each morning. It detoxifies your liver and keeps your body alkaline
(cancer thrives in an acidic body).

I would suggest you ask your doctor to order a liver ultrasound. It can show if you have a fatty liver.

Glucose is made in the liver and the liver also stores iron.  I would suggest you get your ferritin levels tested (measures
iron stores). My iron levels were very high when my cancer metastasized (to the liver, spleen, outer rectum, lung nodules,
nodule on outer colon).

I would definitely ask your doctor about getting on metformin.  That drug got me to complete remission with 34cm of metastatic
tumors, which showed up 2 months after surgery,before I even started chemo. That was Jan 2015.  I have been in complete
remission since August 2015. Remain on metformin and take 44 supplements each day. Also radically changed my diet and lost
30 pounds. Metformin has been known to have many anti-cancer properties since 2005.  It is well known for diabetes and
insulin resistance, two risk factors for endometrial cancer.  The drug saved my live.

I don't know if you work with a naturopath, but there are certain supplements that are very good for liver support.
I also take some key supplements for liver support.

Hope this is helpful.
Takingcontrol 58

 

 

Thanks for your counsel

We have ruled out hepatitis and I did have an ultrasound which was clear.  I am going to follow up on the iron angle and metformin has been on my mind bc of your posts.  So thanks for all the great ideas and info. Oldbeauty

Sandrine04

Takingcontrol58

Can you speack me about metformin ? 

I am stage4 me too and maybe metformin can help me ? 

takingcontrol58

Metformin

Sandrine,

Metformin was approved in 1995 in the US for the treatment of diabetes and insulin resistance (prediabetes).
Gynecologists also prescribe it for patients with PCOS (polycystic ovary syndrome) which is usually caused by
insulin resistance.  In 2005, researchers learned of its many anti-cancer benefits.  It is an inexpensive, generic
medication and is considered one of the 100 most essential medicines by the World Health Organization because of
its safey, effectiveness and low cost. Metformin has been used in Europe for over 50 years.

It has been shown to be partularly effective for endometrial cancer because endometrial cancer cells have alot of
insulin receptors on their surface.  I was insulin resistant (pre-diabetic).I had borderline high glucose levels and
high IGF-1 (insulin growth factor-1), which is a hormone usually raised before the diagnosis of endometrial cancer.  I don't
understand why most doctors don't test for this hormone.  If you are diabetic and taking another diabetes medication, you
should switch to metformin because it is the only diabetes drug proven to have anti-cancer beneficts.  If you are overweight or have
borderline high glucose levels or high levels of IGF-1 or are insulin resistant, you should ask your doctor to put you on this
drug.   All these are risk factors for endometrial cancer.  Metformin has many other benefits that target the processes that cause
cancer cells to grow and metastasize and become immune to chemotherapy. Since there are no effective cancer treatments
that cure metastatic cancer, I would suggest you try metformin.  All 34cm of my metastases disappeared when I started taking
metformin, without cutting out any organs or getting additional surgery. You have nothing to lose. 

If you have had surgery, you should ask to get genomic testing on the tumor they removed.  If you did not have surgery,
you can request Circulating Tumor Cell testing, which will identify gene mutations through a blood test.  Metformin also
targets a mutated pathway found in 80% of all endometrial cancers, the P13K/Akt/Mtor pathway.  This pathway regulates insulin. 
If you have a mutation on this pathway, metformin might be of even more benefit to you.  I had a mutation on this pathway.

Let me know if you have any more questions.

Taking control58