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Anyone on Ibrance have lowering haemoglobin and rising liver enzyme AST? Concerned it may be cancer in marrow....

Olha profile image
Olha

Hi all

I've been on Ibrance and Letrozole since MBC diagnosis in August 2019 to bones and marrow (after primary bilateral mastectomy, immediate lat dorsi reconstruction, chemo, rads, and Herceptin in 2010). Stable CT scans since, but now AST liver enzyme rising, my Ferritin (which is odd with low haemoglobin) and AST is very high, my haemoglobin has started to drop since Christmas after being stable at just normal range of 115g/L, WBC always low from Ibrance so I am on 75mg and a 2 week break. LDH has gone through the roof to 2483 (normal top of the range is 214!). All my other liver function tests are normal apart from AST but I am having a full liver report done. Told it is probably Ibrance or baddies growing in the marrow.... so feeling so very anxious and worried what treatment is possible next. I have read that if you have bone metastases then it is often in the marrow too, but doesn't always affect the blood.

Thank you so much for any input!

Best wishes to you all,

Kate

8 Replies

Hi Kate. I have been on the same drugs as you for a year and bloods are always crashing and have to wait for bone marrow to recover ..I started on high dose now on 75mg and it still crashes apart from that my oncologist say the rest of my bloods are normal never mentions liver . I have metastases in my T3 ..like you I'm worried something going on I'm having a bone scan done and hope all is ok .Because my cancer in my plexus was missed for 2 years .fobbed me of with things like trapped nerve , so tumour has now strangled the plexus which is main nerve to arm .I have now lost the use of arm and my hand is clawed ,I don't trust anyone anymore ..Do if I'm not happy I will push for every test I can get ,.I hope you get good results and no baddies

Best wishes Cherylx

Olha profile image
Olha in reply to Dolphin_

Hi Cheryl Thank you for your reply. I do hope your scan is good and I’m so sorry to hear about your arm.

I’m going to see a haematologist who will hopefully help more than my onocologist.

My best wishes, Kate

Hi Olga, You didn’t mention an Aromatase Inhibitor, are you on Letrozole by chance? That one made my liver enzymes elevate consistently, my Onc disagreed but once I stopped they went back to normal. I’m on Ibrance 125mg and changing to 100mg next cycle due to low WBC. I have a small liver met with the rest in my bones. Exemestane has been working really well for me. I hope that helps and that your doctor can offer you some help and hope.

Olha profile image
Olha in reply to atoth17

Hello!Thank you so much for your reply - that is really interesting - yes I am on Letrozole too. Have stopped IBrance to see if the enzymes come down but still on Letrozole....I’ll have to see what the onc says to that! Was it all liver enzymes - for me it’s only the AST?

girlsptz profile image
girlsptz in reply to Olha

Hi Kate. If you review the toxicity of Letrozole to the liver it rates very low and less than 1% of patients will be effected so I doubt that is the cause. As you know there are several liver enzymes that work as a team so to speak so in order to properly see what is going on your team need to evaluate them together. An AST that is elevated without the ALT being elevated is usually related to muscle or cardiac disease. For there to be damage to the liver the AST would be elevated but so would the bilirubin and both ALP& ALT so it is complicated. LDH is present in most tissues including heart, kidney, liver and skeletal muscles. There are 5 isoenzymes of LDH.....isoenzyme 5 is associated with liver and your doctor can order a test to isolate that. I have extensive bone metastasis and before I started treatment my LDH was very elevated but with treatment it is still above normal range as obviously my bone mets remain but we watch it closely. All the drugs we take are metabolized in the liver so our poor livers have to work hard....I've been on Ibrance 125mg and Letrozole for 33 months and my liver enzymes generally are slightly elevated but it is more about the whole picture and I also closely watch the AST/ALT ratio which is a better gauge on liver health.

So my advice, sit down with your oncologist and get them to review all the lab values and unless you are familiar with what everything reads as a total picture you will drive yourself crazy and cause unnecessary worrying trying to research individual meanings. I'm very familiar with all the readings so I feel confident reviewing them.

Sandra

Olha profile image
Olha in reply to girlsptz

Thank you Sandra. It’s helpfulto know your LDH is still above normal. Apparently my high AST might be something to do with the red blood cells which can also be indicated by high AST levels, especially as no other liver tests are elevated. Am waiting for an appointment with a haematologist and a little nervous as this could mean marrow is being further compromised...unfortunately my oncologist is not very interested in any other ‘terrain’ markers so I am grateful I will now be speaking to other specialists.Best wishes, Kate

atoth17 profile image
atoth17 in reply to Olha

Yes, for me it was all liver enzymes. My Doctor disagreed that it could be the Letrozole but my numbers had been elevated for at least a year (I was on it for seven years). I had not been taking Ibrance yet, I stopped Letrozole when we started to suspect I was stage IV (diagnosed Nov 2020). On paper, Letrozole doesn’t appear to affect enzymes but it ended up being the culprit for me. It may not be true for you but it’s worth exploring the idea with your doctor.

Olha profile image
Olha in reply to atoth17

Thank you. It’s interesting about the Letrozole. I have an appointment soon with a haematologist when I willfind out more! Best wishes, Kate

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