Tarceva and Elevated Liver Enzymes - 1258497

meli80
Posts:24

Dear all,

it has been a while since I've posted here and ever since my mother has been struggling with this horrend disease. She has started with Tarceva by the mid of June. However, ever since she has been losing her strenght, appetite and she had to interrupt the therapy now for the second time due to stomach issues (stomach pain) and also due to rash.

She is on 150mg daily. Yesterday (three days after the Tarceva stop), her blood was tested and in the afternoon the lab called me to tell me that her liver values are strongly elevated. Of course, they did not know that she is on Tarceva and that she has a large liver met (9cm as of 12/06/2013).

Still, I am very worried and until my mother's oncologist calls us back, I wanted to ask the doctors here to comment on my mom's values and what it potentially means. Here are the values incl the comparison to the 2nd oldest ones (also done during Tarceva therapy):

15/07/2013:
70 (AST), 22 (ALT), 69 (GGT), 98 (Alk. Phosp), 1,700 (LDH), 1.7 (CRP)

06/08/2013:
140(AST), 44 (ALT), 194 (GGT), 174 (Alk. Phosp), 3,000 (LDH), 7.5 (CRP)

The upper normal values are: 31 (AST), 34 (ALT), 46 (GGT), 105 (Alk. Phosp), 250 (LDH), 0.5 (CRP)

I have read that Tarceva can cause the elevation of the liver enzymes and personally, I cannot tell if these values are a "mild" or "moderate" or "significant" increase. The LDH value is bothering me too, as it has been correlating with the increase in the tumor mass in the liver. But I also understand that it could be now due to the general liver toxicity that my mom has been experiencing.

Thank you so much!
Meli

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Reply # - August 7, 2013, 08:15 AM

catdander
Posts:

Hi Meli, It's good to hear from you and know your mother is doing alright. I'm sorry she is having trouble with rash and stomach. Often cutting the dose helps with side effects of tarceva because some people are very sensitive to the drug. Also some have stopped tarceva for a day or three to let the symptoms subside then do much better after returning to the normal or smaller dose. There is much written about tarceva side effects here.

The link below is to a discussion about liver enzyme levels. The abbr. are different but the change in numbers are very similar to what you've written. Hopefully you've talked to the doctor and have gotten an all clear. I will ask Dr. Walko to comment on your questions.

http://cancergrace.org/forums/index.php?topic=4580.0

Hoping for all the best,
Janine

Reply # - August 7, 2013, 05:33 PM

dr walko
Posts: 102

Meli,

Liver toxicity is a reported side effect of Tarceva and seems to be more common in patients who have liver involvement of their tumor. Toxicity is commonly graded as below:

Grade 1: 2.5 x the upper limit of normal
Grade 2: 2.5 to 5 x the upper limit of normal
Grade 3: 5 to 20 x the upper limit of normal
Grade 4: greater than 20 times the upper limit of normal

In lung cancer patients receiving 150 mg of Tarceva, in general 4% of patients have grade 2 toxicity and < 1% can have more severe toxicity. It looks like her toxicity is about grade 2 based on the AST and ALT and because she has liver involvement, this is not surprising. I will defer to the physicians to comment on the LDH.

Best wishes,
Dr. Walko

Reply # - August 7, 2013, 10:05 PM

Dr West
Posts: 4735

Unfortunately, I must confess that my interpretation of the picture is that the rising LDH is most likely from progressing disease. Though the rising ALT and AST could be from Tarceva (erlotinib), these labs are so much less striking than the LDH elevation that I think they are more likely to just reflect the same cancer progression or be a relatively small effect of the Tarceva compared with the lack of beneficial effect from Tarceva if the cancer is progressing.

I wouldn't want to presume to know more about her case than her doctors, but that would be my concern.

Good luck.

-Dr. West

Reply # - August 8, 2013, 08:26 AM

meli80
Posts: 24

Thank you for your valuable input and opinion, especially for clarifying what grade of liver toxicity this might be (my worst fear is that my mother's liver function will drop out).

Unfortunately, yesterday things got worse. Mother had a strong pain on the right side, so strong she could not breathe. As my mother is treated in Germany and visiting me until the next scheduled CT scan that is on 28/08/2013, I could not take her to her oncologist just like that, so I took mom to ER.

She was examined with an ultrasound and unfortunately, my - and obviously Dr. West's - fears have been confirmed. The main liver tumor has further progressed, several smaller lesions observable too. They could not tell where the pain comes from, the liver is not swallen and there is also no fluid visible. They assume that it could opress the surrounding, but this I do not understand as the liver has not pain receptors as far as I know. And if it is not swallen, what should cause the pain?

Anyway, we are flying my mother to Germany on Sunday. Tarceva has been stopped for good. She will have a CT scan on Tuesday. The only positive news is that yesterday, when they took her blood in the ER, the liver enzyme values were slightly decreasing in comparison to the previous day's blood work results. But the LDH increased further...

I know that things are not good for my mother and I am mentally and physically exhausted. We need a miracle now, but as my GP told me once: "There are miracles. They just never happen to one own's parent."

This isn't fair. This illness is horrible, it has to be stopped finally by someone in this world. Too many people are dying of it. When I look back now, it would have been better for my mother if she had not received any of these failed therapies since November 2012 (Alimta, Gemzar and now Tarceva). She would have had at least a "normal" life in her normal surrounding. But, we hoped for stabilisation and we still do I guess...

Thank you for listening.

Meli

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