Elevated Liver Enzymes

[Cali3]

Husband on Triplet Therapy Orgovyx, Nubeqa and Docetaxel for Stage IV GL9 with bone mets. First chemo cycle completed. Second chemo was canceled as his ALT numbers were very high (305). AST also elevated at 94. ALP is within normal range. MO is recommending holding off Nubeqa for a week and retest liver enzymes. Anyone else have experience of elevated liver enzymes while on Nubeqa or Orgovyx

[SanOnofre]

Yes, after starting Orgovyx, my ALT reading was 166 U/L and I stopped taking it for a week and ALT came down to normal range.

[Cali3 in reply to SanOnofre]

Did you go back on Orgovyx and if so, did your ALT stay in the normal range afterward?

[SanOnofre in reply to Cali3]

Yes, restarted Orgovyx for additional three months (six months total), ALT lowered to normal.

[Tigger2022]

When my husband started Orgovyx his liver values were a little bit elevated. The MO didn’t have a lot of experience with the drug yet, so worried it was the Orgovyx that did it. He switched my husband to Lupron. But, the liver values didn’t come down and my hubby feels terrible on Lupron, so we lobbied to get back to the Orgovyx. His liver values slowly came down into normal range. We’re not sure what the cause of the liver value elevation was but he’s been on Orgovyx for more than a year and his liver is fine.

[Jazzman2023]

Do they suspect it's the Nubeqa, or the Orgovx that's causing the elevated liver enzymes ? Or they're not sure ? Best of luck !!

[7OaksTom]

I had increased liver enzymes after starting Orgovyx. MO put me on Eligard. My liver enzymes are back to normal. For me, have had much less intense hot flashes with the Eligard. I don't have much in the way of fatigue as well.

[APK3]

A bit late here. Did you ever get the enzyme issue solved ? I've been on both for a year and now have Alt and Ast enzyme issues also .

[Cali3 in reply to APK3]

Yes, we did. In my husband's case, the liver enzyme elevation happened after the first dose of Docetaxel. The MO made us stop both Nubeqa and chemo. The enzymes started going down and we restarted Nubeqa after a week. Enzymes still kept going down and we then restarted chemo at a lower dose.

Can't be 100% sure but it seems like Docetaxel was the likely cause in his case. He is still on Orgovyx and Nubeqa and the liver enzymes are ok.

[APK3]

Thanks for the reply.

[Cali3 in reply to APK3]

Sure. Have your enzymes come down after stopping Nubeqa?

Looking at my notes, the pattern we saw is that the initial drop is rapid but it takes awhile to get back to normal. Once the numbers are below 2x of the upper limit, you can consider a rechallenge at half dose or try another medication.

The other thing we did is to get the RightMed test from OneOme (oneome.com/home-internation... to check for potential drug metabolism issues, specifically, the CYP3A4 enzyme for Nubeqa.

[APK3]

Yes they did come down rather quickly. The cancer center I go to let them go way too long. I think both were about 200x upper limit. Both were in the 800's. After 2 weeks off the Nubeqa they both returned to normal limits. I started a rechallenge a month ago at half dose but the enzymes are creeping up again so I think they are going to want me to switch to Xtandi or Erleada. Not too happy about that as I was not really feeling too many SE of the Nubeqa after a year on it. I thank you for the link I'll check that out .