Bilirubins and Alanintransaminase has... - Advanced Prostate...

Advanced Prostate Cancer
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Bilirubins and Alanintransaminase has risen dramatically after I started Zytiga - should I be worried?

45yrsDenmark
45yrsDenmark

I started Nov 29th with Eligard and 1 month later, Dec 30th, also Zytiga (1000mg) w/ prednisone (2x 5mg).

Blood samples from Dec 23rd (1 week before I started with Zytiga) and blood samples from Jan 24th (after taking Zytiga for 25 days), Bilirubins increased from 19 -> 36 and Alanintransaminase, ALAT from 41 -> 65. Basic phosphatase in same blood samples dropped from 87 -> 72... My PSA luckily also dropped from 32.6 to 6.0 (starting around 90 in Nov upon Dx) which is a good thing, but now I am worried that the liver numbers may be at a level so I need to lower the dose/discontinue Zytiga (and that would be bad) !!!

Any comments - should I be concerned at this point?

25 Replies
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Elevation in liver enzymes such as AST and ALT commonly happens with use of many drugs. If the increase is not very very high, most doctors will ask you to ignore them.

Some people have reported that the herb, Milk thistle have helped them keeping liver OK.

I will continue Zytiga as its very effective and monitor my liver enzymes (ALT ,AST ,LDH) every month.

OK, so in other words, you don't think I should be worried at the levels I have now (after just 25 days of Zytiga)?

Could you clarify your Bilirubin level or provide us with a range and units? Usually, total biliruben has an upper limit of normal around 1.2mg/dL. Mildly elevated AST/ALT are typically not concerning enough for a physician to stop a medication, but only your physician who has the entire picture of your labs and health history can make that determination

gregg57
gregg57
in reply to Shanti1

His Billirubin is in µmol/L and the range 1.71 to 20.5 µmol/L.

Shanti1
Shanti1
in reply to gregg57

Thank you.

gregg57
gregg57
in reply to Shanti1

It was new for me too.

Yes µmol/L (the acceptable range here in Denmark is 5-25).

Thank you- I agree with gregg's comments below.

The ALT is only midly elevated so that wouldn't concern me. The Billirubin is more concerning to me since it is close 2X upper limit of normal. What does your doctor say about that?

I have a doctor appointment on Thursday.. I just went online for a sneak-peak :-) The blood sample is from Friday afternoon... I read that 3 times the upper limit (of 25) is where things are baaad... but I don't know if it usually keeps increasing or it would most likely already have stabilized at this level..? After only 25 days of Zytiga...

The range for Billirubin varies depending on where you get it from. I haven't found any ULN greater than 20 so I'm thinking now that 36 sounds too high.

I know that visible jaundice occurs between 2.5 and 3 mg/DL which is 1.25-1.5X ULN. Do you have visible jaundice? It's best to have someone else look at you.

I did ask my doctor about elevated liver enzymes with Zytiga and he said he hasn't seen it yet and he has a lot of patients, around 24 currently on Zytiga.

No sign of jaundice yet,,,

I agree with the others here about just watching it. We all get nervous when these numbers go out of the normal range, but they would have to go up quite a bit more to be concerning. My doctor said liver enzymes are fairly sensitive so they can and do move around a bit from many things.

What is much more important is that Zytiga is working. You can live with moderately elevated liver enzymes if you have to.

Liver enzymes are not worrisome until they get to over 2-3 times higher than normal. It's something to watch right now.

I also had an increase in liver enzymes on Zytiga but it was temporary and the numbers went back to normal. As others have pointed out, your numbers aren't that high so you're still okay even if they don't drop.

It's perfectly normal to be freaked out by everything right now.

Thanks everyone for feedback and inputs. I am more "OK" now. Just didn't know if I actually SHOULD freak out, but it seems that so far, I should keep calm about those liver values :-)

My liver numbers were out of whack. I stopped Zytiga for 7 weeks to get them normal. I then started back Zytiga at 1/2 dose. Then went to 3/4 dose and have stayed there. I personally believe if Zytiga is going to work 1/2 or 3/4 dose is all you need. Biggest side effect? It does cut into Big Pharma profits.

Hirsch
Hirsch
in reply to GoBucks

I have gone to 3/4 dose also. Do you think it works as well at that dose. I would like to see something corroborating this if you have it. Thanks

GoBucks
GoBucks
in reply to Hirsch

The only thing I have are my PSA tests all <0.01. My cynical view is that they tested zytiga in Phase 1 trials to see the maximum tolerated and effective dose. Once they found 1000mg worked and was tolerated there was no need to further test and see if 750 or 500mg was just as effective. More pills= more profit. Many people are taking 250 with food so who is to say you really need 1000?

Hirsch
Hirsch
in reply to GoBucks

Very intuitive. Will switch to 750. Thanks

Lots of good advice already... let me just add that if, like me, you’re one of those whose liver numbers do go up with zytiga, you may well be able to drive them back down by being nice to your liver - milk thistle capsules worked for me, along with making sure I had a leafy green salad every day, and drank coffee daily. You’re whacking your liver with some horrible chemicals, so give it some good stuff too.

Stuart

I had a similar problem. Stopped Zytiga for two weeks, and then re-started from 250mg and increased by 250mg every week to full dosage. Didn't have any issues after that.

I saw some reports saying that elevetad liver numbers after starting Zytiga and falling within 2-3 months are seen as positive sign for good working therapy

Rkoma

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