Supplements and elevated Liver enzymes - 1262087

tkirzhner
Posts:18


Hi
I am diagnosed with NSLC stage IV adenocarcinoma in August 2013.
No mutations.
Had 2 cisplatin/ Alimta and 4 cisplatin/ Alimta/ Avastin infusions then 2 Alimta/Avastin maintenance infusions.
About 2.5 months ago I added supplements to my daily regimen. The supplements are prescribed by reputable integrative care physician.
All my blood markers were good until before the 2nd maintenance infusion when my liver enzymes slightly elevated. My doc asked me to drop all supplements for awhile.
After a week following the last infusion ( no supplements were taken) my enzyme markers tripled comparing to the already elevated markers.
Is this a proof that chemo is at fault here - not supplements?
Besides the supplements had to help liver not hurt it.
Need an educated opinion please. Thanks for listening

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Reply # - February 6, 2014, 09:52 PM

Dr West
Posts: 4735

There are many kinds of supplements that can do all sorts of things. It's fair to say that most oncologists are wary about their value (me included), since they are generally recommended or taken without a clear recommendation based on something between weak evidence and absolutely no evidence of actual benefit in patients. In contrast, oncologists really try to work within the range of treatments that have meaningful evidence of significant benefits for patients based on careful studies in humans, typically hundreds in a well done research study.

That said, Alimta (pemetrexed) can certainly lead to elevated liver function tests without any help from other medicines, and if the numbers got worse while off of supplements but on ongoing Alimta, that suggests to me that the Alimta is the most likely culprit.

Good luck.

-Dr. West

Reply # - February 7, 2014, 07:19 AM

tkirzhner
Posts: 18

Dr West
Thank you for speedy response! Greatly appreciated.
In your opinion what would be the best course of action to balance the liver without
compromising cancer treatment?
Thanks again

Reply # - February 7, 2014, 07:48 AM

JimC
Posts: 2753

Were the liver enzymes checked at the same time in the chemo cycle? Usually Alimta infusions are given every third week and levels are checked just before the infusion, so if they were checked just a week later they might be expected to be higher. If they remain high or continue to rise, your doctor may suggest reducing your dose, a treatment break or lengthening your cycle to 4 weeks. If not, a change of treatment might be in order.

That being said, when my wife was on Alimta maintenance she had a temporary spike in liver enzymes which resolved itself without any interventions.

JimC
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Reply # - February 7, 2014, 12:57 PM

tkirzhner
Posts: 18

Jim
Thank you for your advise.
My nurse for some reason told me that they do not know
what is causing the spike if not supplements because in their
opinion Alimta is not toxic to liver...
Hmmm...Even pharmacy says it is toxic to liver and FDA trial reports for
Alimta maintenance published on cancer.gov indicate that some percentage
of participants showed elevated liver enzymes.
At least she said to make another blood test in a week.

Reply # - February 7, 2014, 10:24 PM

Dr West
Posts: 4735

Yes, I'd say that most often this issue just waxes and wanes and doesn't require interventions. In some cases where the numbers were worrisome and I wasn't sure if they were going up and up, I have held chemo and watched, then resumed when the numbers dropped, I restarted the chemo (often just a delay of a week or so). In some cases, I've needed to reduce the dose of the Alimta or switch to a different chemotherapy.

-Dr. West

Reply # - February 13, 2014, 02:37 PM

wantvictory
Posts: 16

Hello, I need help with high liver enzymes.
My last liver panel was:
My Liver Panel:
Total Protien-------7.30 normal limits
Albium----------------3.7 normal limits
Alk Phos-------------245 (should be 50-136)
ALT--------------------267 (should be 30-65)
AST--------------------178 (should be 15-37)
Direct bilirubin .08 normal limits
Total Biliruben .27 normal limits
Are these dangerously high? Should I do my next chemo.
My liver is in pain and I have lost 10# in a few weeks. Only able to eat
vegetables. How long will it take for them to go down.
I did NOT take supplement and have had 14 Alimta treatments.
1st 4 with Carboplatin.

Reply # - February 13, 2014, 09:08 PM

JimC
Posts: 2753

As Dr. West said earlier in this thread, Alimta can cause liver enzymes to rise. When Alimta is suspected to be the cause of the increasing levels, it can be held for a week or two to see if they rebound, or the dose can be reduced. If that doesn't work, then it may be necessary to switch to a different treatment. You will want to discuss these levels with your oncologist in order to determine the proper course of action.

JimC
Forum moderator

Reply # - February 13, 2014, 10:15 PM

Dr West
Posts: 4735

I agree that it's absolutely possible that the chemo is the main cause of the elevated liver enzymes, but many, many other things can cause abnormal liver tests as well. If you want to clarify if the problem is from chemo, hold the chemo and see if the numbers improve. It would not be our place to guide what you should do, so I would encourage you to discuss the situation with your oncologist.

Good luck.

-Dr. West

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