Zytiga discontinuation due to high ALT/AST

[Mw921000000]

Hey all, my father has to stop taking Zytiga due to high liver enzymes. What is the next step after this? I am upset because he was responding very well and his PSA came down to 0.6 from 277. We wanted to use Chemo as a last resort. As always, thank you for any help and advice.

[Tall_Allen]

It is a mistake to use chemo as a last resort. It works better and is less toxic if used earlier.

[Mw921000000 in reply to Tall_Allen]

I have a feeling he will start it next. We see his doctor tomorrow. Have you heard of having to stop Zytiga for this reason? Thanks for the reply

[Tall_Allen in reply to Mw921000000]

Yes, many patients report that. Sometimes reducing the dose and then slowly increasing it helps.

[Grandpa4 in reply to Tall_Allen]

Yes mine were high in full dose. Lowered to 3 pills a day and they improved the normalized.

[Mw921000000 in reply to Grandpa4]

Did you do this right away or did you take a break first?

[Grandpa4 in reply to Mw921000000]

Took 2 weeks off the restarted.

[Mw921000000 in reply to Grandpa4]

Good to know. Thanks for sharing!

[Tall_Allen in reply to Mw921000000]

If you stop Zytiga, do not stop prednisone, however.

[Lslal in reply to Tall_Allen]

I’m on the triple therapy and had raised liver results so was taken off of Zytiga for 3 weeks. Was then put back on it but at reduced dosage from 1000 to 500 mg daily. Also going for blood tests every 2 weeks to monitor liver. So far I’m doing okay.

[JPOM]

Would you mind sharing the liver enzyme numbers (ALT, AST & ALK.P)? Mine are also very high, due to a combo of chemo for bone marrow cancer and 2 other meds, for hypertension and AFib.

[Mw921000000 in reply to JPOM]

My dad also is taking other meds for hypertension too, but his doctor thinks it’s because of Zytiga. His ALT is 137, ALK is normal at 113, and AST is 72.

[JPOM in reply to Mw921000000]

not too bad - was diagnosed with probable cirrhosis and liver cancer:

AST 142

ALT 198

ALK.P 494

Got an MRI coming up but looks like I'm heading for the last roundup. The only upside is I'm asymptomatic, other than these tests and scans. Not in pain, not incontinent, can still live independently (good thing, cause I live alone, lol), got my agile mental faculties and rich imagination and count my blessings, not all the comorbidities... ok, I lie - I count those too, can't be helped. Ah well. Fight on, warrior!!

[Seasid in reply to JPOM]

Can you ask for the liver fibroscan?

google.com.au/m?q=liver+fib...

[JPOM in reply to Seasid]

Dunno if fibroscan yields more/better info than a 1.5T mpMRI but no harm in asking. Thnx for the suggestion ☺️

[Seasid in reply to JPOM]

I really don't know, but it is like having 1000 biopsy of the liver and it is a very simple screening technic. Can you also test yourself for hep C? I assume you are immunized against hep B?

[JPOM in reply to Seasid]

Had 13 diff. liver tests, no hep anything. Will research fibroscan before I see Dr. Thx again.😀

[Seasid in reply to JPOM]

That is a very simple screening. Only 10 minutes. No radiation. Easy, and you can always repeat it and follow your liver health.

[Chrisbaird]

Mw I started zytiga @ 1000gm daily with 5gm prednisone 20months ago after 2 months I had blood test than showed liver enzymes told to come over zytiga a month blood test showed improvement in enzymes then went into 500gm daily + 5gm prednisone had no problems with liver and PSA has been 0.01 this last year hope this information helps your situation good luck !!

[Mw921000000 in reply to Chrisbaird]

Thanks for sharing! I’ll discuss this option with his doctor. Hopefully we have the same success, good luck to you also!

[fireandice123]

The same thing happened to me when I first started on Zytiga. I was taking 1000 mg/day and was also taking a number of supplements. My MO had me stop taking everything and retry Zytiga after a couple of months at 500 mg/day with regular tests to check my AST/ALT. After a couple of normal tests the dosage was upped to 750mg and then back up to 1000 mg. All was well. I slowly started retaking my supplements. My liver numbers have been normal since. We still don’t know why my liver numbers went wonky.

[Mw921000000 in reply to fireandice123]

Thanks for the reply! May I ask what your treatment was when you stopped Zytiga for those few months before retrying?

[fireandice123 in reply to Mw921000000]

I was on Lupron during that time. I had started it when I started Zytiga. I remained on Lupron with Zytiga (once I restarted Zytiga) for about a year before taking an ADT vacation.

[mynacho]

when I was dx a year ago with MPC my MO gave me Zytiga with prednisone and I also responded immediately ,my pains disappeared almost but my AST/ALT shoot up to 150/400 so I stopped.After 1 month My MO switched to Erleada 4 tablets a day and after a while I reacted to that with terrible rashes itching and dry skin so he stopped and restarted at 2 tablets a day which I generally tolerate and if the side effects increase I stop for 1-2 weeks then restart again.Since 1 year my PSA is undetectable. I wish you and your father good luck

[Mw921000000 in reply to mynacho]

Thanks for all of this information! Happy to hear you found something that works for you. Good luck to you also

[GoBucks]

You may have stopped the Zytiga too early. Per J & J, you should discontinue if ALT and/or AST are 5 times higher than norm. I stopped when my rising AST went to 126 and my ALT was 258. I quit Zytiga until my numbers were back down to normal. ( about 7 weeks)Then I restarted 500mg instead of the 1000mg I was taking. When my numbers were ok I went to 750mg. That was in Summer/Fall of 2018. Been taking 750mg since and always at <0.01. Good luck.

[Mw921000000 in reply to GoBucks]

I was thinking the same. His doctor is at Sloan Kettering and told him to stop and come in to see him today, I trust his doctor but I also would hate to see him stop something that has worked so well for him. I’ve heard of liver enzymes at much higher levels than what he’s at right now. Thanks for sharing and best of luck to you also!

[rsgdmd]

In my case, my bilirubin went way up after a week on abiraterone, but AST and ALT were normal. As I was about to start chemo, abiraterone was discontinued til chemo is done.