Liver mets: resection, ablation, SBRT, Y-90, anything else?
Comments
-
My oncologist said I am not a good candidate for local treatment because my tumor load in the abdomen and bones is too high
0 -
so a quick update..
I have been on Lynparza since December after Verzenio failed me. I had Y90 done in September because Verzenio was working at the time at least for bones but as some of you may remember I had a tough recovery from that surgery that messed up with medicine metabolism then Verzenio failed.
Lynparza worked well for bones the first 3 months but not liver .. I had two new spots in liver apparently they were there when I did Y90 but IR said they were too small to detect so they got bigger. My options were move on to Halaven, start a phase 1 trail or do another Y90. Against my vows not to mess up with the liver again, I chose doing another Y90. I did the shunt study, I had a plan and it was time to do my regular PET and MRI after 2 months since the medication I’m on seems to be failing (usually it’s 3months between scans). I figured let’s schedule surgery right after scans just in case there are other minute tumors, the IR would have the latest image before going in and hopefully can make last minute adjustments. He said don’t wait for scans but it only added one week to wait so I waited.
I was scheduled to have the Y90 tomorrow but I got the results yesterday. The 3 mets I had got bigger and I have 5 new ones!!!! All in a span of two months!! They are in different locations. One of them actually is in an ablation zone that I did a year and a half ago.
IR said let’s just do the surgery regardless and we can have a plan for the other mets later. But that means I will have to wait at least another 4 weeks to address those, I can’t switch treatments and apparently Lynparza is doing nothing for liver. So in 4 weeks I may have an explosion in liver at that rate!
I asked him to consider postponing surgery for a week or so and have a plan to get them all done at once. After consulting with his team he said there’s no way he can do it all at once and I may even reach my maximum allowance of radioactive medication and have to resort to ablation for a couple of them. Yet he still thinks doing Y90 is better option. I told him why don’t we do chemo again now to shrink them then hopefully deal with less mets if we need to. He responded that recent research suggests that doing Y90 after chemo has a higher risk of liver damage and less success rate.
I’m really overwhelmed, disappointed yet grateful I didn’t do the surgery a week ago!
I’m leaning towards Halaven but really not mentally ready to go back to IV chemo with all its drama: neutropenia, hair loss and other side effects.. ugh!
Besides, I feel Halaven is my only real last option.. going there so soon means I’m nearing the end
Any words of wisdom?? How was Halaven for those who tried it? Anyone tried fasting with it? Any supplements that made it work longer?? Did cold capping work??
Please pray for me ..
0 -
Hi,
It depends if your oncologist and radiologists are working in the same cancer center. My oncologist is scheduling treatments in between Y90. Good luck
0 -
crosspost from liver thread :
For you ladies who did Y90, how sick did it make you? I'm over a week out from my second (they were two weeks apart) and not on any chemo until next week. But the fatigue is still awful, and I'm nauseous a lot and occasional vomiting (more like heaving). I keep thinking there must be cancer somewhere in my body that has grown and is making heave. Or I'm just having extended side effects?ABSunset
0 -
Sunset, sounds like Y90 side effects to me. I had much more side effects when I had my right lobe done compared to my left and had a long break between the two (8 weeks). I can't imagine having procedures 2 weeks apart and have honestly never heard of anyone having the two lobes spaced so closely together. After my right lobe, it took a good month to get past the fatigue and general malaise feelings. Were you prescribed prednisone? I hate steroids but taking a 7-day course did make it much more tolerable after Y90 for the first 7 days. I was booming with uncontrollable energy from the steroids . . . following by a crash on day 8. My nausea didn't last long although I have always had an unusually strong stomach and rarely have any nausea from all of these treatments. However, I did have a very bad round of Doxil after my right lobe Y90 - the hand-foot syndrome side effects on my feet were much more pronounced to near intolerability/toxicity - my feet were covered in blisters covering a dangerously large surface area and making it nearly impossible to walk for several weeks, which I believe is because my liver was compromised healing from the Y90 and didn't have the capacity to properly clear the chemo that round. It was somewhat of a perfect storm that the second Doxil cycle which I was undergoing is always the worst, I did the Y90 and then had the Doxil without taking any chemo break and I did some other no-nos with my feet that I didn't know were a problem around the time of my infusion. I did not have the same issues after the left lobe, which is so much smaller. Also, I recall voluntarily taking a week off before having my next scheduled Doxil after the left lobe treatment. You probably need to allow yourself a few weeks or longer to get past the acute symptoms and at least a month to feel almost back to normal. Maybe longer because your procedures were back to back with no time to recover between the two.
0 -
NouzayO if you did systematic treatment while the liver mets were there you would be able to assess response. If the chemo shrunk the liver mets then it likely is working for mets you can't see. Chemo might decrease the burden of disease and Y90 can be used in the future or never if you have a complete response. That is my hope for you! Hugs to you
0 -
I ditto what JFL about assessment of your symptoms.
I had a few painful SE of y90 for about a week with each one. But, I was only on Ibrance/ femara during the procedures. And, I believe waiting longer between procedures is best. Mine were 5 weeks apart. Plus, even a scan right now would not show how effective the y90's were. It's way too soon for a scan according to my IR.
I believe your symptoms are not from Cancer anywhere else. Sorry sunset that you are experiencing so much pain and discomfort.
0 -
Grannax, good point about the scan. Typically, when Y90 is working, the liver lesions swell at first as they are dying and light up around the edges. My IR warned me it would be a good 5-6 months before a scan would be meaningful. My first scan (needed for independent reasons relating to my chemo) showed just that - some increased lesions that lit up in a weird way. The report labeled it "progression". My MO called the radiologist to explain about the Y90 and the report was amended to state that the scan showed indications that the Y90 treatment was working.
0 -
Sunset-I only did the Y90 once and I had a lot of fatigue and nausea for about 6 weeks. I lost about 20 pounds due to the side effects. My MO said she had never seen me look so tired. But it was worth it because I am still stable and I had the procedure in December of 2015.
I can not imagine doing two so close together. You are a strong lady! Rest and take care of yourself. If you do not feel better let your doctor know.
0 -
Babyruth. I want to be like you. But progression happened. Third line TX is X and I have no SE right now. The possibility of another y90 is out there but not yet my MO says. She wants to see X working on lung , chest and liver first. Plus, she says I will have to go off of X if I have another y90. So, I wait. UGH I'm so ready for June to get here because my MO appointment is June 12, she will put in the order for PET. Finally, I will get an answer to Is X working? Depending on results, I will bring up y90 again.
Such a process we go through. I get tired of it sometimes. It is a reality, though and it does make sense. First things first.
0 -
Hi to all! Just had my consult with an interventional radiologist from Hopkins about my liver mets. His suggestion is to do chemoembolization rather than Y 90. He thought that this was a good starting point. I believe that this is the TACE that has been written about before on BCO (although he didn't call it that.) I have 5-6 liver spots according to my scans, with the largest being about 2 cm, and the others being sub centimeter in size, scattered across both lobes. He said that he would not treat all at one time, but would do some, starting with the largest, on the first go-round, have me scanned within the month, and then see me in about a month to decide if we go back in or not to go after any remaining spots. He said side effects are mainly a dip in energy a week to 10 days later for a few days. He also wants me on systemic treatment, of course, so I am waiting for a call from my oncologist to see what this does with respect to Ibrance (because of the possibility of infection.). Right now, I am still on letrozole, but she wants me to change to fulvestrant and Ibrance. Didn't know if this info would help anyone.
0 -
And yet another report/methodology to consider regarding liver mets -- sent my scans and lab reports to Dr. Robert Lewandowski at Northwestern because he agreed to take a look and give me his opinion about what to do about my liver mets. Some of you may recognize the name -- he's the doc who has researched/written a lot about treating breast cancer mets locally as well as systemically, rather than just systemically. He has suggested ablation of ONLY my largest lesion, which is just under 2 cm. Says, if I understand correctly, that the other lesions are very tiny and going after them with chemoembolization could actually cause a problem later on for me because the chemoembolization could weaken the liver and preclude later treatment or change what later treatment might be available to me if needed. He thinks that regular meds (I'm about to start fulvestrant and Ibrance) could very well take care of the tiny spots which he doesn't think have enough independent vascularization to make use of the chemo agents injected into them.
So his vote is what I guess I would call "limited ablation." Again, passing this along in the hopes that it helps someone else in considering different local treatments for mets to the liver. My understanding is that ablation can only be used on a very few spots; otherwise you go to other treatments.
Bev
0 -
Bev, I would want to discuss Dr. Lewandowski's "limited ablation" recommendation with the Hopkins interventional radiologist. Given that you are early in your systemic treatments, it seems reasonable to hope that Ibrance/Faslodex could wipe out your small liver mets and ablating the larger one is prudent. Kudos on getting in to see the experts and many thanks for sharing what you are learning!!!
I'm also investigating local liver treatment.
Cross posted on Liver and Clinical Trials threads. I'm struggling with a tough decision and would greatly appreciate input. I recently progressed on Xeloda and had my first liver lesion appear on PET/CT (1.7cm SUV 9.6). My liver was clear on PET/CT 3 months ago. My oncologist suggested a Phase 1 oral SERD trial (G1T48). Other options were Affinitor/Aromasin or Alpelisib/Faslodex. I have an ESR1 mutation and have progressed on tamoxifen, letrozole and Faslodex/Ibrance. I told my oncologist that I wanted local liver treatment, so she referred me to an interventional radiologist and liver surgeon. I chose the oral SERD and took one dose last Tuesday and did blood draws all day. I'm scheduled to start daily treatment this Friday. I met with the liver surgeon on Friday. A liver MRI showed only the single lesion at the edge of the liver which is "easily resectable." The surgeon will be gone for 4 weeks, so kindly offered to fit me in tomorrow (Monday). We were thrilled! Then my trial coordinator said my oncologist advises against surgery because I may/will be eliminated from the trial. I asked before going on the trial whether liver biopsy/resection was allowed and was told yes by trial coordinator (oncologist was at ASCO). Now trial coordinator says can't have liver resection within 14 days of starting trial. The surgeon's scheduled is extremely booked when he returns in mid-July. I LOVE my oncologist and don't want to go against her recommendation or hurt her trial, but I'm terrified that by July I will no longer be eligible for liver resection due to progression. Should I postpone the surgery with the hopes of rescheduling in July? Any thoughts?
Thanks! Theresa
0 -
Theresa I noticed your SUV 9.6. That's a very high uptake meaning it's very active. Higher than any of my tumors ever showed. Logic would tell me get that monster out of there. I believe a combo of systemic and local is best. I know in your case you would have to stop one to do the other because of the trial rules. But does that mean you could not start the trial again after you recover?
All that coming from my perspective of no systematic TX has worked on my stubborn liver monsters, only y90 worked on them. All the hormone therapy was wasted on me. That makes perfect sense now that I know about ESR1. Not only wasted but made me feel horrible for two years. I think that's why I feel so much better on X. I know X failed you. I'm so sorry to hear that.
It's Monday and I believe you said the surgeon only had an opening for today. So, you have already made decision.💞
0 -
Grannax, I decided to go ahead with the liver resection today. My high 9.6 SUV of my liver tumor did play into my decision. It is likely that I will not be able to restart the trial, but I'll find out later this week. If not, I will need to look at A/A, the newly approve alpelisib (I have a PIK3CA mutation) or IV chemo. I will find out when I meet with my oncologist on Thursday.
I hope that you will get a long, effective, and tolerable run on Xeloda. The hand/foot syndrome was an issue for me, but other than that I felt great on Xeloda. Icing my feet, 40% urea cream, and lots of thick moisturizers worked best for me. I also had to ration my walking and give up hiking. I was still able to cycle. The good news is that after 2 weeks of Xeloda, my feet are looking great.
Best wishes! Theresa
0 -
Good for you, Theresa. Having a plan, whatever it is, always helps me feel better. Glad that liver monster will be destroyed by this evening. 💞
0 -
Hi from Denmark 😊
I had an RFA (2 liver mets) two weeks ago tomorrow. Just wanted to know if it’s normal to feel pain after two weeks? The pain is not constant - it comes and goes and always at the same place (probably where one of the buggers are!).
Also I would like to know if anybody got nerve pain after RFA? My belly feels like a bee stung me when my clothes touches a certain part of my belly 😬 Auch!
Thanks in advance
0 -
I haven't had RFA but I'm sure some who has will chime in with answers. You might also post on the " How are people with liver mets doing?" Thread.
0 -
Hi all, I have not posted in quite a while. Have had the luxury of doing well for the last year. I have had progression on H&P. A single lesion but it is @ 2.5 cm and wasn't discernible 3 months ago. I talk with IR next week about the smorgasbord of options and what they may recommend. I am assuming ablation and y90 will be on the menu. I have an appt with my 2nd opinion doc the next day. Guess we will be changing my systemic therapy, too. Presumably to T-DM-1. I am looking back thru postings for words of wisdom. Sounds like y90 has worse SE's and more risk than I had realized/anticipated. I am going to try to read more about people's experiences with ablation. I will flip over to the liver mets discussion, too. Thoughts suggestions appreciated - especially key items for my question list.
One more thought: I have not had genomic testing done but my MO and I have discussed, in general, the possibility of doing that. She wanted to wait until we heard from IR before doing that planning. Genomic testing and clinical trails are on my "discuss" list. Anyone done Strata testing? I will search for posts on their testing.
Thanks for sharing wisdom.
0 -
Hi, Lumpie. Sorry you've had progression. The only thing I know about ablation is the the tumor has to be in a good location for that procedure. I asked my IR about it when I first progressed and he told me mine were not.
I have had genomic testing twice, once to Foundation One and most recently to Tempes. I changed MO and my new one is at a big center and uses Tempes. Approximately the same results but much easier to read on Tempes.
Other than that, I have no words of wisdom about your questions. I'm sure someone will. Hoping for the best for you. 💞
0 -
I had the laparoscopic liver tumor resection last Monday. I'm still taking pain killers, so it was a little more painful than expected. II'm very grateful that Dr Visser agreed to remove it. Liver resection is used often in mets to the cancer from colon cancer. It is not "standard of care" for breast cancer mets to the liver. I believe that local liver treatments can buy us time, whether it's liver resection, RFA or Y90. In y case I was particularly interested in local liver treatment because I'm heavily pretreated (tamoxifen, letrozole, faslodex/ibrance, Talzenna, and Xeloda).
Time will tell whether my liver resection was useful. I'm sharing my experience in the hopes that it might help others.
Best wishes to all!
Theresa
0 -
I too had a liver resection and was able to be NED for 2 years after. So don’t rule resection out.
0 -
Thanks so much for the input on treatments, Grannax, theresa and leftfoot. I spent much of the day yesterday trying to read up and look at my images. It does appear to me that the tumor is at the anterior, inferior margin of the liver which makes me a little surprised that they don't seem to have me lined up to talk with anyone about resection.... but I haven't really talked with anyone at all yet. How was recovery? Can you tell me how long your hospital stay was? Were you in ICU post-operatively? I'll ask the docs this week but am not sure what factors they weigh in recommending resection vs ablation. I know that resection is still a bit novel for MBC but my doc did mention it when I was first diagnosed.
Theresa, thank you particularly for sharing your recent experience. Sure hope you are feeling better soon!
0 -
Lumpie,
I'm having microwave ablation to one liver spot in early July at Hopkins. That will require an overnight stay only.
Apparently, all of my records and scans went to the liver tumor board, and the surgeon on the board said no to surgery (resection). I even had to push for the ablation versus chemoembolism. And my MO at Hopkins didn't want to do anything other than systemic treatment, but she's going along with it because I pushed. Sounds like you MO might be a little bit more open minded about local treatment, so good for you.
0 -
BevJen, Thanks for that insight. I am with an HMO and it kind of seems like if they can do it in-house and it is supported by evidence, they are very open to it. That is usually a plus. It does make me a bit nervous that I don't think they do the ablations that often. I do think that the recommended treatment sometimes reflects local expertise and preference as much as clinical evidence for a particular methodology. My tumor is @ 2.5 cm and I was reading that one of the techniques... and I think it was RFA... the article I was reading said you needed 2 cm margins. If that is correct, that is a huge chunk out of one's liver. I have a note to seek clarification from the docs. I have thought of going to Hopkins for a second (or third) opinion. I have stuck closer to home so far.
0 -
update:
MRI today showed improved liver Mets since Y90, but massive progression of spinal Mets (and a few other things that are not yet, but may well become, problematic.) My platelets were too low to have chemo today, and I'm off to cyberdude tomorrow to get control of pain from spinal Mets. No chemo during radiation and until platelets rise. So, one thing at a time, I guess. At least my liver, which was kinda life and death, is currently under some control. Not sure how to feel.
Sunset
0 -
I'm sorry about your mixed results, Sunset. And your pain. Radiation should help a lot, though.
Very happy to hear liver improvement, and chances are that they still may improve some more from the Y90, right ? I would much rather battle bones than the liver, but I know that the whole situation is a bit overwhelming.
Good luck in your bone treatments, and I hope your pain resolves quickly.
0 -
sandy- in my house we call it wack s mike- you take care of the most immediate need, wack it and then deal with the next.
My brain Mets and liver Mets don’t respond th the same treatment do I alternate between those.
It ducks but is doable.
Glad your liver looks to be resolving and now you can take care of the bone Mets. May you achieve s nice stable state soon.
0 -
Sunset, great to hear the Y90 is helping your liver mets! First things first and that was your most critical area. It must be disappointing to hear about the bone mets. Did your bone mets ever become resistant to hormone therapy? The tamoxifen I am taking with my Navelbine seems to be helping with my bones. My liver is very resistant to hormone therapy but not my bone mets.
0 -
Sunset Yay y90, boo bone Mets. I know bone Mets can be more painful than liver mets.........go figure. Hope you get some relief.
0
