Bilirubin Spike - Advice wanted

[Em234567]

Hello. I was looking for some advice on behalf of my mum who is currently undergoing treatment for metastatic melanoma. About 21 days ago her routine bloods indicated unusually high liver enzymes (ALT/AST at 1000+) thought to be medication induced liver inflammation. As a result her targeted therapy was paused and she was put on to 60mg of prednisone daily. Since then her ALT and AST levels have dropped to 300+ however in the last week her bilirubin has spiked at 140 from 50 last week and 11 the week before. Her consultant has no explanation for this and has just said to watch and wait, he also said she only had a 50% chance of recovery!!

It doesn’t feel good to do nothing...so I wondered has anyone been through something similar? Is there anything we can try to help? I have asked about coffee and milk thistle but our consultant didn’t know if we should try this or not. Is there any other possible medications/treatments.

Any ideas?

Thank you for reading

[Hidden]

Hello, welcome to the forum although I am sorry about the circumstances.

Targetted agents can set up quite a dramatic response where the body attacks itself in its efforts to get rid of the cancer cells. There are several potential side effects including inflammation of the gut and also the liver. The prednisolone is aimed at stopping that inflammatory process. It is good that the ALT and AST have dropped although they are still well above normal. It is possible that the bilirubin has just risen more slowly - hopefully it will stabilise and then start to reduce.Occasionally the dose of prednisolone needs to be altered in order to further reduce the levels. I expect your mother is under the care of an oncologist - they could perhaps speak to a hepatologist (liver specialist) with regard to the liver tests if things don't settle down. I would hope that your mother also has the contact details of a specialist nurse for advice. Hopefully your mother will be able to restart her medication soon.

We would always advise extreme caution with regard to trying complementary therapies such as milk thistle. So called 'health products', liver detox products etc are not regulated in the same way as prescription medications and they can cause more harm than good. It is always best to discuss this with the medical team although I note this question has already been asked of them.

regards