Elevated Liver Enzymes AST/ALT

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sunnysocal11
sunnysocal11 Member Posts: 11
edited August 2021 in Chemotherapy - Before, During, and After

Hi everyone. From searching on here, I’ve read that elevated liver enzymes are pretty common. I did want to ask, for those with elevated liver enzymes, what ranges did you see for AST and ALT? (4 rounds of dose dense AC) Was there a specific range you met that required to push your chemo back? I’ll be asking the oncologist next week before chemo infusion but figured I’d ask here since most of the posting on this forum that mention elevated liver enzymes don’t mention the numbers associated or if it didn’t allow them to continue chemo.

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  • moth
    moth Member Posts: 4,800
    edited August 2021

    in my province they do a 75% dose reduction if lfts are 2-3 times upper level of normal. If it's >3 times ULN or bilirubin is 20-50 micromol/l then they dose reduce 50%... this is the adriamycin protocol... there are more steps in the dose reduction.



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  • sunnysocal11
    sunnysocal11 Member Posts: 11
    edited August 2021

    Thanks for the response. I guess I'm more interested in knowing what kind of AST and ALT numbers people were seeing during their cycles. The dose reduction and possible delaying treatment seems to be more in line with where you're getting treated and the guidelines they have there

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  • moth
    moth Member Posts: 4,800
    edited August 2021

    I think the general rule of thumb does seem to be start worrying a bit at around 2x the upper limit of normal. So if you look at your lab results and see the range, see how much higher you are than the top number. If you're just a bit over, barring other factors, the MO is likely to not be too concerned. Here's more about how interpreting liver tests. https://www.dynamed.com/approach-to/abnormal-liver...

    "it is common practice to describe abnormal liver function tests by their relationship to the upper limit of normal (ULN) for that test, or by ratios of the values of the tests, to control for variations in normal ranges between labs and techniques of analysis

      • A borderline AST and/or ALT elevation is defined as < 2 × ULN.
      • A mild AST and/or ALT elevation is defined as 2–5 × ULN (rarely greater than 300 IU).
      • A moderate AST and/or ALT elevation is defined as 5–15 × ULN.
      • A severe AST and/or ALT elevation is defined as > 15 × ULN.
      • A massive AST and/or ALT elevation is defined as > 10,000 IU/l."
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  • DivineMrsM
    DivineMrsM Member Posts: 9,620
    edited August 2021

    sunny, years ago I when first diagnosed I had chemo and did not have issues with ast/alt numbers.

    In mid-2019, I was put on Verzenio until stopping in February 2020. (It was especially hard on me physically, cost me thousands of dollars, failed to stop progression and when I finally quit it, I required a blood transfusion due to extremely low red blood cells that would not recover on their own.)

    I pasted a copy of my lab results for ast/sgot for that time period. You can see how it began to rise in October 2019 and continued until Feb 2020, then began lowering after I stopped V. However, it wasn't due to this rise that I was taken off Verzenio, I had increasingly horrible side effects from it which drastically affected my quality of life. The onc never mentioned the rise in the ast numbers as anything troubling to her.

    My alt numbers stayed within range as did my bilirubin. I thought you'd just like to see the numbers I was getting for comparison.


    image

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