Link between MBC Progression, Fatty Liver & Liver Enzymes?

[Half-Full]

My wife’s tumor markers have now risen 6-fold over the past few months (60 - 356). The two most notable changes in her health are extreme fatigue and drenching night sweats.

While her scans are still relatively stable they have shown worsening diffuse fatty liver and her blood work is showing quickly rising liver enzymes (AST & ALT). There are some reports of diffuse fatty liver causing things like night sweats, but there’s a link to her MBC progression here that her physicians and I cannot figure out. The link is unquestionable as this has happened the past 3 times she has shown MBC progression and has had to change treatments. After getting on a new treatment her diffuse fatty liver subsides, the liver enzymes come down and the night sweats reduce.

We have limited explanations for this:

- Her diffuse fatty liver is actually MBC spread that’s not manifesting itself in solid tumors

- Her MBC progression is triggering a Hepatitis type reaction for some reason

- Her MBC progression is exasperating a chronic (as yet undiagnosed) viral type reaction, perhaps CMV (Cytomegalovirus) which is usually mild but for the immunocompromised (which she is) it can be severe and affect the liver

We’re planning on trying to do a PET scan (as opposed to a CT) to see if there’s increased uptake in her liver and also do some additional blood work for Hep and CMV but it’s a tough time of year to get anything done quickly.

We’re trying to leave no stone unturned so I thought I would see if anyone else has experienced diffuse fatty liver, elevated liver enzymes and symptoms like drenching night sweats come on fairly suddenly with rising tumor markers and their MBC progression? If so, have you been able to figure out why these things are happening in tandem?

As always, thanks so much for any feedback and I hope you all have a safe and happy new year!

[Hopeful4Cure]

I am sorry to hear this for your wife. Hopefully someone here can assist, as I, thus far have not had probelms with fatty liver or poor numbers with regard to my enzymes. However, I think it is a great idea to get a pet insted of ct, as it will show more and the uptake is quite specific. Stay strong, get a second opinion if possible. Sending positive energy.

[Adele_Julia]

sorry to hear of this circumstance. I’ve heard that switching treatments can bounce tumor markers and blood markers around for a month or two . high liver markers) may indicate the flushing of cells or a side effect from a particular treatment ( Ibrance, Verzenio, Piqray etc). I think the petscan is a great scan to do for an overall picture. I take supplements for my liver . It is called Tudca. If you are estrogen positive my Nurse told me to stay away from Milk Thistle. Thank s your wife on an estrogen blocker? This can also give night sweat symptoms . Best and blessings !

[Beattheodds]

I too have seen an increase in my ALT/AST numbers which was verified to be related to a side effect from Ibrance. Cancer drugs are powerful and can cause many health issues, but keeping cancer in check is the necessary evil. Unless side effects intolerable or causing other dangerous conditions, we need to soldier on. Our previous lives of optimum health is now a battle for life.

[Half-Full]

Thanks for the replies. She’s been taking Xeloda for the past 9 months. Her drenching night sweats, fatty liver, liver enzymes and tumor markers were all increasing when she started the Xeloda as her MBC was progressing, they then resolved after being on the Xeloda for a couple months, and now that she’s in progression again they have returned. So it doesn’t appear to be from the meds, it appears to be related to the progression. This is the third cycle of progression where all these things happen in tandem.

[Bettybuckets in reply to Half-Full]

what do they think they will try next? I just started my run with xeloda and if it doesn’t work they said next up IV chemo.

[Half-Full in reply to Bettybuckets]

Probably IV chemo, likely Gemzar which were told is fairly well tolerated and there’s generally no hair loss. We’re also trying to get into a clinical trial and watching the FDA approval process for Elastracent but both of those options may not happen soon enough.

[queeneee]

I have liver mets and have taken Cape.. I found the side effects unworkable and noxious at the level they insisted I take it - I like your approach, and it could be a side effect of the Capecitbine (xeloda) . It didnt work for long either.

[DDIL1]

have you done any new genomic testing to see if she has any new mutations that could also cause a spike in progression. My markers have been rising found I now have ESR1 mutation. The liver piece is confusing, I also agree on PET.. FES if you can get it Cerianna is the maker and the have patient advocates that can help get it accepted and paid for.

Does she have flank pain or bone Mets on her spine?

[Half-Full]

Her MBC spread is primarily in the lining of her lungs and her bones. Neither of which anyone feels are very safe to try to biopsy. We previously had genomic testing done on her blood about a year ago and we plan do have another genomic test done on her blood this week. She’s ER+ and had a slight mESR1 mutation. So AIs may be somewhat compromised due to the mESR1 mutation but the new oral SERD Elastracent should work well if it ever gets approved. Just don’t think we can wait to make a change until the FDA makes their decision on this.

We discussed the PET FES and haven’t ruled it out but in my mind it’s only a partial picture. If it would allow you to compare a full PET to a PET FES then you can make some meaningful conclusions to how much of your activity is driven by ER. But by only looking at a PET FES you’re potentially losing sight of the forest for the trees.

I could be wrong but I don’t think you can see any non ER progression on a PET FES. Great new tool but I guess I’m struggling with the application a bit without the full picture to compare it to.

[Bettybuckets in reply to Half-Full]

I had a lot of scans like all of us… and they all said stable disease when actually it had moved into my liver about a year ago. Feb2022 I had a car accident after gettting a stable CT scan at the oncologist just 2 weeks befor the crash. Long story of dueling CY and Pet scans always giving a stable picture. Last week I had an abdominal Ct scan and then it finally all showed up. That was just 2 weeks after getting an all clear from a Pet scan! This is due to lobular cancer vs the more common ductal cancer. My doctor describes it growing not in usual clumps seen on scans but rather like Saran wrap making it sneaky.

That may be helpful for some woman. You wife is probably ductal as 90% of MBC is. Still. I wonder if the more specific abdominal CT scan is what you need?

[Half-Full in reply to Bettybuckets]

Sorry you’re going through that. Good info on lobular vs. ductal. I wasn’t aware of that. Thank you for sharing.

[Half-Full in reply to Half-Full]

I was able to get a copy of my wife’s original pathology report from almost a decade ago during her original Stage III diagnosis. While we were always told she had ductal carcinoma, and there are multiple references to that in the path report, it also states that she had “residual infiltrating mammary carcinoma with ductal and lobular features”.

So it sounds like the lobular component could explain why her MBC spread generally does not show well on CT scans and does not seem to present as solid tumors. We were able to schedule a PET for next week to get a better idea as to how she’s doing.

Seems like we continue to learn more here than anywhere else.

Thanks Bettybuckets and to all who provided feedback.

[Nhorwath]

Hello - I would ask for a liver biopsy and an abdominal MRI. Also, are all the enzymes rising, or just ALT/AST? if it's just those two, it could be related to the treatment. If it's all of them (ALT/AST/ALP/Bilirubin) then it could be infiltrated liver disease. From what I understand from my oncology team and personal experience, sometimes it's hard to see infiltrated disease on scans, but an MRI and biopsy will be able to tell for sure. And, chemotherapies like Taxol actually help greatly with that sort of disease presentation. I recently went through this; however, only two of my enzymes were rising (ALT/AST) and it was determined to be a drug injury from Ribociclib, not infiltrated disease; however, my doctors ordered MRIs and biopsies to confirm. I hope you are able to get some answers.

[Bless_68]

I had stable ct scans but ca markers were slowly rising . I had some on and off discomfort right around my flank area thus an ultrasound was requested this showed an accidental findings of a small lesion in the liver. When a PETScan was done I lit up like a Christmas tree in the liver and some lesions were also found on the spine. This didn’t show Ip in the Ct. I have night sweats every now and then. A biopsy of the liver lesion was done and it showed that my MBC mutated from progesterone estrogen positive her2- into triple negative. No wonder fulvestrant and xeloda didn’t work after changing treatments when kisqali and letrozole stopped working. Ian now on eribulin IV chemo 2nd cycle and liver enzymes and cancer marker continue to rise.

[Half-Full]

Thank you for sharing. I am concerned the liver issues are more than diffuse fatty liver. I hope your IV treatment begins to take effect and you quickly see reductions in your liver enzymes and tumor markers. The more I learn the more I struggle to understand how most oncologists will not fight for routine PET scans.

[Bless_68]

it’s probably because PETScan is more expensive than a CT. Also, not all insurance might cover the cost if it’s just done as routine rather than being more necessary for more accurate diagnosis. I live in Australia and it’s covered by Medicare for patients with breast cancer.