Blood markers changes during mTNBC treatment

TNBC74

Hi

I was diagnosed 12 months ago with a metastatic recurrence of TNBC (3 years after initial Stage II diagnosis of TNBC followed by a double mastectomy and 4 cycles of AC + 4 cycles of T), with mets to the sternum and liver.

I cose Xeloda as a first line treatment vs more aggressive treatments. That lasted about 6 month with a stable disease before progression. Currently on an Eribulin/Pembrolizumab trial.

Given blood work nearly every week, I track various blood markers, chiefly LDH, CA 15-3, CA 27-29, ALP (as well as others). Initially LDH, 15-3, 27-29 all fell. After 2 months, LDH started to rise again (4 readings in a row) while the CA 15-3/27-29 (tracked every 3 weeks) still fell.

What does rising LDH (from a low of 225 to 300) while CA 15-3/27-29 falling mean? (Note: I am not doing anything strenuous that could cause LDH to rise abnormally).

Thank you!

KPW3

Hi TNBC74,

I can't help with the abnormal labs....but I might be getting into this trial though...will know in a few days. How are your side effects?

TNBC74

hi

Sorry for the delay in replying. Hadn’t logged in a while (and navigation in here is not the easiest!)

Anyways, I assume you started the Eribulin/Pembrolizumab trial? I was on it for 4 months (feb to June) and had to come off because despite pretty good response in the liver Mets (which continued even after 5 weeks after the last dose of E+P), a chest tumor started growing again after initially decreasing for 2 months.

Side effects got worse as the trial progressed: Fevers (upto 104F), muscular aches and fatigue. Ideally I’d have liked a break but remained on the trial.

KPW3

Hi, I have been on the trial since June. I've had a good response in the liver. It's too bad you had to come off, I wondered if they considered a pseudoprogression...Maybe not since you were responding in the liver. The trial rules are quite fussy. I had to take a break after having an exciting autoimmune response in my kidneys in Aug (acute kidney injury). After a huge dose of prednisone (which I'm still on a taper) my kidneys responded immediately and are now normal. I went to a specialist at Dana Farber and am now back on the trial drugs and am being carefully monitored.

I'm having quite a lot of muscular aches and my neuropathy has progressed in my fingers. My fatigue has gotten better since they started me on synthroid, since my thyroid is no longer functioning....was starting to behave abnormally before the trial but is a common autoimmune issue with pd-1's.

Are you still on Halaven?

TNBC74

hi

That’s fantastic that you are still on the trial and responding. Unfortunately for me the trial was using RECIST standards and not iRECIST - the latter takes into account pseudo-progression for immunotherapy but since this was a mix they were using RECIST which is fairly black-white it appears. Also, they did not take consider a large liver lesion as a target for RECIST calculation and so a response there didn’t count (if they had, the calculation would have shown “stable” disease or <20% growth and not “progression” which is >20% growth) while the large chest tumor present - which grew from the nadir - WAS counted.

Having said all that the muscular neuropathy was getting worse and the 5th and 6th cycles of the Eribulin along w the Pembro caused fever were exhausting and the QoL sucked. Ideally I’d like to have taken a break and/or reduce dosages rather than quit altogether especially since we spent 5 weeks to decide on a new treatment plan rather than have one at hand. But since this was a trial I think they don’t have too much flexibility and also our docs didn’t seem as comfortable w immuno as they are with chemo where they had more experience.

And yes my thyroid was shot by the 2nd cycle along with my hair. On daily thyroid meds (levothryoxine) at 150mg a day (6 days/week) since then (started at 50 mg and raised it till the endrocrinologist felt the dose was right)

Right now on standard Gem/Carbo to see how that goes.