Liver mets: resection, ablation, SBRT, Y-90, anything else?
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nouzay What a horrible 7 weeks! So, it sounds like your liver did respond well to the y90? My IR, who gives his cell to all his patients, said the most definitive scans are 3-6 months after y90. So, in regard to response in liver you might see even better results a few months from now.
I wish you could have taken a break from TX for the whole seven weeks. Hindsight is 20/20. I don't have bone Mets but I know how painful they are. Way back in 2000, I had mets to C3. A horrible place to have mets. I could barely hold my head up, literally and figuratively. The end of that horrible story, after SX to remove and fuse etc etc etc, is I have no pain now and no other bone mets ever appeared. I do know there are other ladies who have had the surgery you mentioned. Tanya is one, maybe you could look on bone mets thread. I would vote for rads t seems like your body is saying stop, give me a break.
In all statistics about all types of TX there are numbers of the few who have horrible SE. You are one of those. Try not to focus on liver mets progression right now. I don't think any IR should consider that on you for a long time. Your body and mind need time heal. All of that coming from me, ha, who whisked through two y90. Therefore I shouldn't give advice to you. I'm almost 18 months out from successful y90. But, I did have a PET that showed increased uptake in my liver in September. We did an MRI and it didn't show up, so we did not change treatment. Scared, yes. Worried, yes.
First things first. This phrase seems to help me focus.
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Hi everyone.
I have to admit Im overwhelmed. My eyes are fried.
I'm very new to mets to the liver. Im confused. Forgive me if I sound hopeless. Y90 is radioablation. If my whole liver has mets. I have 5 lesions one about 5 cm. How can this help. I feel it would make the liver like swiss cheese. Im probably not thinking of it correctly. Wouldn't more lesions pop up eventually since its already there?
Im hoping medication will shrink it. My sister is pro surgery. There is some type of liver surgery in Pittsburgh that is suppose to be a cure . (I will get the details)
Im starting xeloda only. I Received my biopsy of my liver it was her2 neg.
Prior to the mets to the liver I had rt sided skin mets locally. Radiation did the trick. I had never had node involvement until a month after this radiation was completed. It came back in the left axilla node. Ibrance cleared my node and dropped me to ned .
Fortunately Ibrance and fasolodex gave me 2yrs. (While my doctors told me my tumor markers were fine and no imaging was necessary. Although he ordered a dexa to make sure I had strong bones lol.) Needless to say Im finished with that awesome Onc.
Anyways. I have become skeptical. Chemo never worked for me. Ibrance was the best remission I've had.
Im going crazy with what next.... .......
Sorry. I do agree the more imaging the better. I am also worried if my liver would look worse on a MRI.
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Nouzay, glad you have come out of the darkness and that you are okay. I was so relieved to receive your PM. You are probably right about your liver not functioning at full staff, which caused you to be overly sensitive to your medications for a period of time. I had a very dark month with Doxil which I believe was a result of the Y90 to my right lobe and my liver functioning below par. It was a bit of a perfect storm with a few Doxil contributing issues. I didn't have the same issue with left lobe which was performed after the right, likely because it is much smaller than the right lobe. I know that one doesn't need the left lobe at all to function and our livers can get by on the right lobe alone. Sorry to hear about the bone mets lighting up. It is hard to know what to do when it could be caused by having to lower your dose and take time off of Verzenio. It is tough to think about giving up a med that may be working, given we have so few options. Continuing under tight monitoring + radiation could be an option.
Funthing42, welcome to this group. It can be very scary and overwhelming when first diagnosed with Stage 4 and liver mets no less, but things will get a little better once you have your treatment underway. Xeloda is highly effective on liver mets. It is taken in pill form in an inactive state and activates in the liver. I had a good run on Xeloda - 14 months - it shrunk my liver mets significantly and my liver did a lot of regenerating on Xeloda as I had mostly BC mets and little liver tissue in my liver when I started Xeloda a few years back. Y90 is not radioablation where they zap the tumors. It is radioembolization and is the one treatment that works on widespread liver mets. For some reason, liver mets mostly use the hepatic artery to get blood supply. Healthy tissue uses the hepatic vein. A small catheter is moved up through the hepatic artery and "mapped" so it specifically targets the blood supply to the tumors while leaving the healthy tissue alone. Once the catheter is ready, micro-sized radioactive beads are sent into the hepatic artery where they then lodge in the tumors and open up to emit targeted radiation to the tumors.
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JFL your explanation of y90 makes it all make sense! I've read a lot and had two y90 but still did not understand it until you explained it. You go girl. Now, would I be able to repeat it? Very doubtful. LOL
Anyway, it worked. At least so far. We just have to move to the next best thing. Funthing. It sounds like you might be a candidate for y90 but you won't know unless you get a consultation with an I R who has experience with y90. It would be wise to consult then make your decision about local TX.
I hope for the best for you. You can read all about everyday of my experiences here on this thread. I tend to write long stories, so you may not want to read it but it's here. Start back in March 2017. Maybe you've already read the other stories. Shetlandpony is three years out. We all want to be like her. But, everyone's story is slightly different.
Let us know yours, please. We gain insight from each other.💞
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Thanks Grannax and JFL for your advice.. I need all the advice and prayers I can possibly get!
I’m really considering staying on Verzenio (100 mg) maybe going back to the intial dosage of 150 mg for the next couple of months and do scans earlier instead of waiting for the whole 3 months. As you said, I don’t want to give up on something that might be working .. I had three back to back drugs that didn’t work and on which I progressed.. they didn’t even last the three months period (beyond the PET scans that is) .. so I’m a little hesitant to try something new especially that the options they are giving me are not that appealing: afinitor or Lynparza (I have somatic BRCA not genetic) or Halaven.
Not all drugs can be given at the same time of radiation so I’ll still be without drug coverage for about a month if I do that.
I’m just worried because my MO is not in favor of just sticking with Verzenio. But to me it’s all risky .. you know if the bone mets were in any other place besides the spine I wouldn’t be in such a conundrum.
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Thank you for the warm welcomes.
Superb explanation of y90.
Love it
Hugs and caring vibes casted your way.....
Some more random thoughts has anyone tried any alternative therapy in conjunction with chemo.
For many years I was afraid to take multivitamin because of interactions with treatments.
I just started taking supplements and herbs. Tons of them. Juicing like a mad woman. Thoughts in regards?
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NouzayO- So glad you are doing so much better. Would the addition of Faslodex to the Verzenio make sense? The combo has been working for me. I take 100 Verzenio twice a day and Faslodex monthly.
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thank you Sandilee!!
Yes! I do take Faslodex in conjunction with Ver
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Grannax said above "ShetlandPony is three years out". (Hi, Grannax!) Actually ShetlandPony is now over four years out since the liver mets diagnosis. I haven't done Y90 yet because Xeloda is working, but my onc did send me to consult the interventional radiologist aka the liver guy, and we are keeping this treatment option in our pocket for the future.
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Shetland Pony don't know how I got things so mixed up. Sorry. But, I still want to be like you. I f I change treatments to xeloda. It's doing a great job for you. Yay. My MO said my next treatment will probably be AA, I think I would rather take X it seems better for liver. I know it's harder on toes, though. I saw you post about your new nail. Yay
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Congrats on 4 years Shetland! Awesome Xeloda has been working for so long.
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Nouay O, Grannax mentioned to me about the khyphoplasty and radiation. I did have khyphoplasty on my spine in April of 2017 bc of a fracture and the cancer in my spine. Then I had radiation which reduced the pain and size of Met. In July of 2018 I had khyphoplasty again same disc different side fractured. At that time a biopsy was also done. The khyphoplasty reduced the first time but after the second one I still had pain but it was determined that it wasn't from the tumor since it hadn't grown. The pain was the relentless type that doesn't give you a break so I had yet another surgery to inject steroids into my spine not the same area. Unbelievable, it worked the first time although they recommend you do it two or three times. I sometimes get an achy pain when I do too much but mostly I'm not in pain. I hope this was helpful. Everyone's outcomes are different.
Tanya
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Thank you, JFL. I have been on Xeloda for 1 1/2years. Lol, Grannax2, I don't expect you to keep up with my history. I tried Afinitor and Faslodex for four months but it did nothing. The oncs think that the anti-estrogens are easier than chemo and seem to want to try AA before chemo, but I actually feel better on Xeloda than I did on anti-estrogens + targeted therapy (Ibrance + letrozole; Faslodex + Afinitor). I find that having lowered the Xeloda dose from five to four pills per day after the first year makes it sustainable for me. That nail would not have come off if I hadn't bashed it.
It's a weird cancer, this one. ILC is supposed to be so darn hormone-driven, yet I recurred on tamoxifen after only three years, and after five months of Taxol I only had a year on Ibrance + letrozole before tumor marker started creeping up (stayed on it for another year until scan confirmed progression), nothing from Faslodex + Afinitor. But the Taxol I had as the first treatment for stage iv got me to NEAD, and now Xeloda has got me to NEAD again. The other weird thing is as far as we know there are still mets only in the liver. So I like to think of it as oligo and it seems like the latest research points to local treatment for oligo. Which is why I think Y90 might be the next thing when needed. So thanks to those who have done Y90 for posting here and educating me.
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Shetland, I too found Xeloda much more tolerable than Ibrance/Aromasin/Faslodex and Ibrance/Afinitor! Honestly, I found it more tolerable than the Tamoxifen I took when I was early stage too. Good thinking to look into Y90 now. My DH thought I was jumping the gun when I started researching and "prepositioning" the idea and planning nearly a year before I had the treatment. However, I was ready to go and have it very quickly without a delay in treatment when Abraxane became untolerable and I showed some mixed results and possibly minor progression. At that point, my DH did a 180 and told me it was so good that I planned everything out in advance. I would recommend you do that if you can - float it with your MO (which may take some time for him/her to get on board - mine took 4-5 months to come around and is now a big proponent, research/select an IR and try to schedule an initial consult, get yourself registered in the system if it is not at your normal cancer center and provide the IR with all the scans and BC history he/she needs). I am a planner when it comes to BC contingencies and am always thinking about my next treatment while the current one is still working.
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You may remember when I was in the fashion show about a month ago. During the day I was interviewed by Suzanne Lindley and filmed by John Bruner. Now, the interview is on u tube. I will type the link but if that doesn't work, try my name Vicki Medlin.
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Grannax, thanks for sharing the video. You are so well spoken! Loved watching it.
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Thanks JFL
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Thank you for posting! Well said and filmed. SBRT to liver works too, 18 months out and still NED everywhere!
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That's awesome, bstein.
JFL, that's good advice about planning ahead. I am lucky; my onc was the one to bring up Y90. I am at an NCCN center, and she sent me to see an IR there who was treating bc patients with Y90. I had consultations and scan and was set to do the mapping and a liver biopsy at the same time. We had put it on the schedule and the IR had left the room, but he looked on the computer once more to see if that day's tumor marker results were in. He came back to say that my new drug Xeloda had cut the number in half after just one round. He and my onc communicated and agreed that we should keep Y90 in our pocket, and he would keep an eye on me so as not to miss the window of opportunity. So fortunately it should be a simple matter to arrange for Y90 when the time is right.
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Thanks bstein. Yay for SBRT. Shetland pony. Yay for xeloda! That's great news but you are so smart to have everything in place just in case you need it. There will be no time wasted if becomes necessary.
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Grannax-love your video! You look so beautiful and I love seeing your family. What a great job you are doing getting the word out about the Y90.
I just had my 6 month scans and they came back as stable. December 1st will be my 3 year anniversary since the Y90. I feel very fortunate to have found success with this treatment.
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Baby Ruth. Three years is so awesome. I hope to get there someday. I do hope the video will help someone. That would be gratifying to me. Thanks for watching it. I will have my scans in December, after my scare in September I'm anxious to get them done and hope they are definitive.
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I am cross-posting this from liver mets and Doxil threads:
Well, I had a PET scan on Saturday and my DH was able to access the results today - bones inactive/stable (going on 4 years now), all areas in liver in both lobes where I had Y90 inactive and shrinking. However, there are two new lesions in my liver - one in each lobe, 1cm and 2cm. Feeling super disappointed and worried. Not sure what is next, I will be going on my 6th line of treatment. I suspect my MO will recommend Halaven but I honestly don't feel up for another standard IV chemo right now. I am pretty wiped out with the anemia from Doxil and need a break. My immune system seems to be so low, which doesn't seem like a good state to successfully treat liver mets. Also, I still have a lot of neuropathy in my feet from Abraxane, my previous drug, and don't know how much more my feet can take - I don't want to compromise my ability to walk and have to be mindful of balance issues as it is. I understand Halaven causes neuropathy. For a while, I was getting too thin but have been able to "beef up" a bit after getting a blood transfusion for the anemia (my appetite returned to normal afterward, which was surprising and great).
I meet with MO on Friday and I expect he will not be giving me Doxil. Some options I am thinking about are: metronomic therapy (cyclophosphamide and possibly methotrexate or Xeloda), Verzenio, Navelbine and Halaven. I am also looking into clinical trials for HER2 "single" equivocal (meaning IHC equivocal, FISH negative rather than "dual" equivocal which is equivocal on both tests). My DH is going to call my MO tomorrow to "float" the metronomic therapy idea per my request. I would like to give my MO time to look into it and run it by some peers before my appointment. My MO may be open to it but it is not something he would suggest on his own at this point, given it is not a common therapy and also given how well I have tolerated the side effects of my previous treatments.
Any ideas on possible treatments would be welcome. As you can see from my signature block, I am in the "heavily pretreated" category at this point.
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Has anyone had Y90 more than once? My MO mentioned it yesterday.
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JFL. No, but I've been wondering the same thing.
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Help my liver mets have increase in size. My bone mets are stable. I ask for Y90 a couple times but only got talked around it. Well today it was on the table but so was others. I can do 1.gemcitabine (which thats what my Dr. wants) 2. Y90 but after we talked I'm scared. 3. 2nd opinion or 4. Guardant 360 test. I asked my oncologist to get the referrals ready for a second opinion and to talk to somebody about y-90. I also have to get assistance for the blood test. (Which I asked him to start) but the best advice is those who lived through it , experienced it .I've tried to read through this and do my own research. But it's hard for me to understand it. Any help would be truly appreciated.
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Melle,
Y90 will kill your existing mets but cannot prevent new ones, you still will need some form of systemic treatment. My experience with Y90 lasted nine months before new mets appeared. The treatment itself was relatively easy with little aftermath. Take your scans, cmp's to an experienced IR who has treated breast cancer patients with mets in the liver.
Consider waiting for the guardant360 results as there may be something actionable on your systemic treatment.
A second opinion is always a good approach when you want feedback on your treatment plan. I have often consulted with other medical specialists who assist me in my care.
Max
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JFL and Grannax,
Additional info on Y90:
I do not have RILD after all, both IR's indicated ascites could not be controlled with medication if the source was RILD. You can repeat Y90 but for me the risk would be substantial and I am considering other options since I still have trace amounts of the fluid. I feel well , look good in the current snapshot and am weighing my next step carefully.
Thinking of you both, hope you had a good day.
-k
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Max. I'm glad you have less fluid sorry you cannot have another y90. I'm waiting for my next scan to determine if I can have another y90. December scan confirmed new ones growing in liver, too. I got 18 months from my y90's. I got two years on Ibrance and five weeks on AA. I started X on Monday, 3000 a day. I'm feeling queasy and have pain. But I want it to work. After the next scan it April, I will go see my IR and see if I am a candidate for another one.
Belle 83. You can make your own appointment with an experienced IR. My advice is to do it. Where do you live?
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