My husband's labs recently indicated liver damage, so the doctor had him stop Zytiga. Subsequent labs showed some improvement, but labs (liver enzymes) are still elevated. The doctor has told us that Zytiga isn't an option at this time. Has anyone else had this experience? I know there are other drug options down the road, but losing this option has hit me hard. Thanks.
Background:
Diagnosed March 2017 --- Stage IV with one bone met confirmed with bone biopsy; some lymph node involvement.
April 2017 - Started Lupron
PSA dropped from 17 to 3 by May
June 2017 - Sept 2017 - Six cycles of Taxotere chemotherapy
PSA dropped to <1 by July
October 2017 - Started Zytiga
December 2017 - PSA of <.10
Written by
TNCanuck
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"The severity of the liver injury linked to abiraterone therapy has been generally mild, consisting of transient and asymptomatic elevations in serum aminotransferase levels. The product label recommends measuring aminotransferase levels every 2 weeks for 3 month and monthly thereafter and stopping therapy if levels rise above 5 times ULN. Abiraterone has not been linked to cases of chronic hepatitis or vanishing bile duct syndrome. There is no information on cross sensitivity to hepatic injury between abiraterone and other antiandrogens, such as flutamide or bicalutamide."
Thanks, Raul. I knew there was some change that it could cause issues. I guess it's more about my being surprised that they took him off Zytiga so quickly, when labs weren't completely off the charts. The article you linked makes me question that even more. I appreciate it!
The procedure should be to determine risk and benefits, if any drug is really needed in general they recommend to stop it if liver enzymes are 2 or 3 times the upper value of the normal range and not because they just increased a little.
Prayers that he has a VERY positive response. My grandfather had metastatic bone lesions and horrible pain, so I know something about that, unfortunately.
He's lucky to have you by his side. My goal every day is for my husband to feel encouraged and supported (and lucky).
I am learning that self care is important. I sort of collapsed emotionally after running on adrenaline after the initial urgency and fight-or-flight response, but I am learning. Yoga, meditation and being more open with understanding, faithful friends is helping.
Yes I can relate, I too hit rock bottom. One day our daughter said mom are you doing all of this ( research, journal, networking, appointments, grants, his nutrition etc) because you are nervous? I said no, but, in retrospect, l realized most of it was indeed anxiety.
I started acknowledging I was becoming depressed., memory was poor....then I realized i would be of no use to him, our two children or any other family member.... or myself!
I got back in the gym, started being more mindful of my nutrition and allowing my self to be present in my pain as well as in my pleasure. I also reconnected to my spiritual self, I felt a lot of anger towards God.
Here I am, some days are better than others.... when he is ok I am usually better. The pain is by far the worse, because I feel so helpless.
Sending lots of healing thoughts your way, and to all the others in this group.
Thank you for sharing, NG. Most of your words could be mine, and while I don't wish this pain on another soul, it does bring me comfort to know I'm not alone.
Sending prayers and positive thoughts your way....
I was on Zytiga for about 6 weeks and my PSA went from 2.1 to 0.07. My testosterone went from 571 to 7! Yes, 7. However, my liver enzymes became 10 times normal, and I had to quit cold turkey. I will find out the first of January whether I can go back or go to Xtandi. Too bad it was working so well. I will, however, get another Lupron shot.
Enzalutamide (Xtandi) should be an option for him. It's equally as effective. Hepatic injury is one of the reasons why people switch from Zytiga to Xtandi.
The doctor didn't mention Xtandi, but he may be waiting for labs (due again in 4 weeks) to completely return to normal before looking at the next option. Thanks.
Xtandi is a great option, some say the best option. Many go straight to that rather than Xytiga. There are also people that start on Zytiga, then go to Xtandi if it no longer works. I will probably go straight to Xtandi when I get to the point where I need it.
How high did his liver numbers go, Is there other meds that could add to the toxicity that could be changed? Liver numbers should recover, mine did when I stopped triple dose casodex. It looks like he is in a good place disease wise now at least.
Aspartate Aminotransferase got to 50+ Normal is 5 - 40 unit/L (back to normal last week)
Alanine Aminotransferaseas high as 105 Normal is 0 - 55 unit/L (down to 90 last week)
I don't think he's taking anything else that would impact liver function. He's on Lupron and has been on a low-dosage blood pressure Rx for 10 years. Guess we'll see what the docs say once happens when the levels return to normal.
Yes, he's in a good place overall, I think (and pray). Maybe things are supposed to be this way and he'll end up on a low dose of Zytiga when it's needed more.
Thanks ---- glad to know your numbers returned to normal.
Apparently it is not. My husband's looking forward to kicking the prednisone in two weeks, though. He sees the positive in everything...every single day!
When my liver numbers were out of range they were both over 2 times upper limit of normal, The liver is an incredibly resilient organ, I think he will be fine, and yes perhaps a lower dose when he recoveres. I will keep you and he in my prayers. Also like to say when triple dose casodex caused lft to rise, not one other drug in this disease caused them to rise, and I have done them all.
That is encouraging. Thank you for sharing and inspiring those of us who are newer to the PCa fight. Your example and prayers are just what we and others need!
I had 5X upper limit normal on ALT, not even sure why. Could have been the chemo I was on or possibly from Bilcalutamide. It does go back down once you remove the insult.
The Prednisone is given because the adrenals do not produce any steroid hormones so patients could go into shock because of lack of cortisol, aldosterone etc. etc. Being an anti inflammatory drug prednisone could help with a liver inflammation, but the main reason is to cover the lack of steroid hormones produced by the adrenals when one is taking Zytiga.
I didn't like taking Prednisone with my chemo, so I tried without it. The side effects got 3 times worse without. That was the end of that experiment! So I used it for at least the first week after infusion, and a little longer if the side effects were still bad at that point. It really made a big difference for me with chemo.
in reply to
Raul80,
Thanks for information about Prednisone use with Zytiga. I thought it was to protect the liver, but cortisol replacement is the reason. Learned something new. Thanks.
The Liver loves bitters, dandelion, wormwood, rue, celandine, milk thistle and golden seal. I also give him Swedish Bitters, which is a combination of 11 herbs..
Here are some Liver Loving herbs:
Dandelion greens, endive, artichoke, onion, garlic, radicchio and lettuce.
I had the same issue with Zytiga couple of months back - almost two weeks after started taking it. I stopped it right away for two weeks, and went back on it, but started at 250mg dose and worked it up to 1000mg over a month. It is normal now again. The potential culprits for me were:
- not taking it on empty stomach (zytiga becomes much more potent with food)
- taking it with statins
- other supplements
I showed the liver numbers to my GI, and he just shook his head, saying until you breach the 3x multiples, it does not warrant urgency.
I stopped taking any additional medicine (except prednisone) and then, started adding them back in one by one to see if I can identify the culprit. The liver is back to normal. No culprit found.
All this shows how different we all are, and how we react differently to exactly the same medication. I’ve been taking 1000mg Zytiga with 5mg Prednisone for 6 years, and had no liver problems whatsoever. I also take a lanzoprazole every morning to protect my stomach. As I noted in another thread I started, my PSA progression has been quite astonishing. I’ve never taken a supplement in my life, apart from alcohol twice a week😁.
In addition to others, my husband takes the same supplement as you. And the docs told him eliminating alcohol would make no difference in his liver enzymes.
I am going through that currently. I started taking Zytiga early January. I had my labs taken this past Friday. My PSA dropped from 5.5 to 1.3 during those 5 weeks which was great, but like your husband, my liver readings shot up almost 8 times normal! My ONC told me to stop the Zytiga immediately and scheduled more labs every 4 weeks so we can see what my liver returns to normal. Yes we are in the same boat.
My latest labs taken April 13 after being on 500 mg Zytiga/day showed my PSA at 0.68 and my liver readings dropped to 3.4 times normal. I was told by my ONC to stop the Zytiga again for a few weeks to allow my liver readings to drop, then start Zytiga at 250 mg/day. He’s looking for a happy medium between PSA and liver impact.
Sorry to hear of the bad experience with Zytiga-- was on for 5 years along with Prednisone before stopped working. Now on Xtandi but doesn't seem to be working. New drug, Apalutamide (Erleada) appears to be similar but more effective than Xtandi. See if it is option. Best of luck..!!!
Glad to hear you got five years out of it. And wish you all the best on your next options. I believe Erleada has only been approved for non-metastatic PCa, so not an option for DH.
My husband stopped Zytiga on 2/17/2018 cuz SGTP was 160. On 2/27, SGPT down to 74 (NL 13-61) ; waiting to hear from MO to see if he will put him back on zytiga at a lower dose. PSA started out at 29.26 and was 0.71 on 2/27.2018. . Was diagnosed in August 2017 Stage 4, Gleason 9, some bone mets. Only complaint is back pain but tolerates it with 1 02 tylenol or advil each day. Started out with Casodex for 1 month and Lupron since Sept. Zytiga was started on Dec. 19, 2018. What a roller coaster ride but we work hard at taking it one day at a time.
My husband has been on Zytiga for 1 month with great results, except his liver enzymes are becoming elevated also. Waiting for a response from his doctor.
My 71 year old father was died taking zytiga. He was only on the medication for 2 months. Heart Attack followed by liver failure. His cancer was stable at the time of his death.
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And the docs told him eliminating alcohol would make no difference in his liver enzymes. 
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