Liver mets: resection, ablation, SBRT, Y-90, anything else?
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Stubborn Liver tumors 🥴 no new mets -yay! But my ct scan showed minimal growth in all 3 tumors-considered stable by MO.
But SO wants shrinkage to go ahead with resection. Surgery is not ruled out if I get shrinkage.
MO said she was ok with SBRT but breast RO said the 3 tumors would require a lot of radiation and referred me to get an MRI and consult with gastro RO so more questions there
Meanwhile MO wants a new biopsy for the molecular study since old biopsy is out of tissue and liquid biopsy showed nothing which is unusual. Good to have so I can see what other meds will be available MO is worried about going through the current choices too fast
i have had growth on 3 months of verzenio/fazlidex and now3 months on high levels of Xeloda. MO wants me to stay on Xeloda 2 more months since it slowed progression of the aggressive tumors. I Guess I can wait 2 more months through the holidays with X then hit it hard with another chemo to get shrinkage. MO said she would not even suggest one until after the biopsy
Will talk with interventional radiologist about the other options like y90 or various ablations when I have the biopsy in 2 weeks.
MO said try to keep on current dose of 2000 mg morning and night. I hate the HFS which is my main SE on X but In it to win it!
Dee
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My y90 is over and I have not felt as bad as I did with my first ones. He also said he was able to treat all the big ones and little ones in my right lobe. I’m feeling some discomfort in my right upper liver area which I think is normal after y90.
I’m just glad that this one is behind me. Maybe I won’t dread the left lobe as much.
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So glad to hear that Grannax, and I hope the rest of your recovery is comfortable and swift!
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Thanks, Katty. I woke up a lot during the night but feel okay this morning. So far my liver is not complaining. Good start for today.💞
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grannax glad you are recovering well 👍🏻
My MO is trying to set me up with an IR to discuss their local treatment options such as Y-90 and RF ablation. She is all for local therapy since surgery is off the table for now and SBRT does not look like it may be an option ( 3 tumors in right lobe in different qu adrants & fear of not enough remnant liver)
I will have to decide if having an IR procedure now is better than surgery later. I could still get resection later next year if and when the systemic treatment causes shrinkage and not just holding. There is even a possibility of IR now and surgery later. It is a little confusing with my stubborn tumors.
The benefit to IR treatment for me is to lower the tumor burden and possibly lower the Xeloda (4000mg/day).
Keep us informed of your progress. It helps to read of others experience even though each case is different.
❤️
Dee0 -
AlabamaDee I found out yesterday that my IR has successfully used y90 while patients are on chemo. He says capecitobine and X don't cause any problems. Although, Avastin and Gemzar do. Interesting. I'm glad I'm off of Gemzar. My next chemo will probably be Capecitobine, so I'm relieved to know that it will be OK. I was concerned because on the SIRTEX website it said capecitabine was contraindicated.
I wrote directly to them and told them they should research and remove that incorrect information. I wonder if I will get a response back from them. Hahaha I'm being very bold in my old age. Lol💞
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Katty. I found out that Say Yes to Hope is having another rustic retreat in April at Cedar Creek Lake in East Texas. I could contact the founder with your name and number if you want me to. Just PM me.I can't guarantee that there will be an opening for you, I don't know how big the facilities are or how many the foundation can sponsor. I sure would love to meet you.💞
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thanks grannax
Good to know about staying on X through y90.
That is why I can’t get surgery. Since the tumors are slightly growing while on treatment they are concerned about them growing right back in the liver, or somewhere else after surgery since I cannot be on any chemo/targeted treatment for 6-8 weeks
I should know my options in a week. My MO actually called me to let me know she is work on getting a consult while I go back next week for the biopsy and MRI.
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Sounds like you have a really good MO.
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AlabamaDee,
Just fyi -- when I had a microwave ablation to a single lesion in my liver this summer, I was on faslodex. I went on Ibrance about 3-4 weeks after that, but stayed on the faslodex the whole time. Had no issues with healing from the ablation. So not sure why you are being told 6-8 weeks without other treatment.
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bevjen
Surgical resection will take my entire right lobe. I would need a portal vein embolization first to start the left lobe growing. Can’t be on chemo meds which affect the liver while it regrows. Since my mets are not shrinking they are afraid that the tumors will reappear with the growth factor of the liver regeneration.
I’m complicated 😉
Dee
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Dee,
I was thinking more of other localized treatments. Sorry for the misunderstanding. Yes, your situation IS complicated. Wow. Good luck!
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So, TMI but I didn't have a BM for six days after my y90. Misery. Even with taking several things to prevent constipation, it still happened. I remember with my second y90 in 2017 I got severely constipated, so I tried to prevent it this time. All I can say is that will start ahead of time for the next one.
I don't have much of an appetite either. And my stomach actually hurt all night last night. It's not actually nausea but nothing tastes good. I don't want to take anything that will add to this problem. It's not going to hurt me to lose a few pounds. But, this tummy pain needs to go away. It looks swollen, too. I guess it's part of recovery from y90.it feels like the inside of my stomach is raw. I do have reflux and have taken meds for that for years. Dr.gave me an RX Carafate, I am taking it.
I guess we just live and learn.💞
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Grannax...many on here know I suffered with consitipation..well suffer... I actually thought I prolapsed my rectum a week ago..it was SOOOO BAD. For my ovarian surgery last Monday I took no pain killers because of consitpation and even doing that just the 40 min surgery alone almost constipated me..I have had to take 600 mg magnesium citrate Miralax 2 times a day for 6 days...eat prunes...but ya know what...I WENT 1 day after surgery I went!!! Then things went the other way for 2 days ...lol now I am normal... The miralax 2 times a day works Oh I also got 2 things people here recommended Glycerine Suppositories and I did use one that 1st day I went. This other combination of stuff from amazon a pill...if you need it Ill get you the name.
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AlabamaDee, I didn't know that the entire right lobe could be taken in a liver resection. Is that common? I have heard of the entire left lobe but it is much smaller. If you are able to eventually have the resection, does the surgeon expect the left lobe to regrow into the chamber where the right liver is located? Do you have any mets in your left lobe now? The risk of cancer regrowth during the liver regrowth stage does make sense. It is like we just can't win with all of these variables and factors.
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JFL
The key with liver resection is how much remnant liver is left to live on while the liver regenerates. We need greater than 20%. So my left lobe is just that amount. To be safe they would do a portal vein embolization to stop the blood to the right lobe and let the left lobe get larger. After resection the liver tissue regrows but not blood vessels or bile duct.
My 3 tumors are only in the right lobe but diffuse, thus the whole liver would come out. because the tumors are aggressive and resistant the surgeon is holding off until I get shrinkage.
MO said I can proceed with other local therapies. Seeing an IR to talk Y-90 or other ablative options. IR choices are not a cure but surgery can be if the tumors show shrinkage response. Thankfully the SO said Surgery can still be an option later with the right choice of local and systemic treatment
Meanwhile X is my systemic treatment until mid January when we reevaluate. MO wants me not to run through the options too fast. X is my 2nd line and did not get shrinkage on high dose in 3 months- only marginal holding. I may hold off on IR until January since I am looking at Christmas time for treatment - yuck.
anyone here have ablative procedures instead of resection or SBRT? Radio frequency, cryogenic, ultrasound? If I get tumor burden reduced then I may be able to reduce X and have less SE. the HFS is no fun.
Dee
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I'm eight days out from y90. My body seems pretty normal, the first six days were painful. GLad to be on the other side of last week. I actually lost five pounds in six days. That tells you about the lack of appetite.
This time the anesthesiologist said they wanted me very still so he used gas and breathed for me. I was still able to wake up pretty easily after a few hours. But I imagine the different anesthesia had something to do with a few of my problems afterwards. If I was an IR wanting to get those microspheres into exactly the right places, I would want my my patients to be very still, too. Precision is key to this procedure being successful. My I R told my family that I had lots of mets that were the size of a bee bee. And big ones too.
The right lobe is not scheduled yet. He wants to do labs on the 11th to make sure my liver function numbers look good. I think this is important, especially for a second set of y90's. I'm glad he's being cautious. I guess it's still possible for me to have the next one on December 18. But, I won't know till after the lab results come in.
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Grannax Happy Thanksgiving! Glad you’re finally pain free and the intervention worked well for you. I hope you continue to benefit for many years to come....
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Grannax
Glad you are feeling better. I noticed one website instructions on Y-90 said avoid public transportation, sleeping in the same bed etc for a whole week. Is that your experience? I did not realize how radioactive you could be afterwards. I get my IRconsult in 1 week
Dee
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It seems like every IR has different instructions. Keeping three feet away from people, especially children and pregnant women, even pets was on my list. It's just for a few days. I totally forgot that I shouldn't hold my cat on my lap, so I did and he didn't have any problems.
Let us know about your IR consult. Hope it goes well.
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Yes, every IR has different instructions. Mine said I could stay in bed with DH, go to work (I think I went back after being home 1 day after the procedure only or something crazy like that), be around son (3 at the time) but that my son shouldn’t be in my lap or near my abdomen for long periods of time. IR’s only major area of concern was exposure to body fluids (such as urine) and he said I should use a different bathroom than my family for a week.
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Hello everyone,
my mom was first diagnosed with breast cancer four years ago. Back then she only had one affected breast and a couple of lymph nodes. After the surgery and the radiation, the cancer treatment was concluded.
Sadly five months ago the doctors found out she has five liver tumors (one bigger than 5 cm) from the breast cancer she had had four years ago (Her2- and ER+).
She is currently taking Palbociclib (100) and Letrozol but we are worried about the number and size of these tumors and this is why, we would like to know what kind of local treatment you are recieving for your tumors and what worked best. Also her oncologist does not want to do any kind of local treatment, because of the number and size of the tumors. Is this normal?
There is also another thing that buggs me: Every month she needs to pause the treatment for an additional week due to neutropenia and this is why the oncologist has reduced the dosage to 100 and may reduce to 75. From what I have read, if she took abemaciclib instead of palbociclib she would not have to pause and with this drug the neutropenia is less common. So here is my question wouldnt it be better to switch her meds to abemaciclib? Also since in the liver mets grow fast, the fact that there are no pauses seems to be advantegeous. What is your opinion? Has anyone been in a similar situation?
Thank you in advance.
I wish you all the best with all my heart!
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PinkPink, sorry to hear about your mother. Neutropenia is the signature side effect from Ibrance. Nearly everyone needs to lower their dose, usually several times. I would suggest she consider lowering it down to 75mg now if that means she can go without a treatment break. Ibrance is nevertheless very effective at delaying treatment resistance for those responsive to hormone therapy. If it is working, then stay with it as long as it works and is tolerable. Your mom can always do Verzenio (abemaciclib) down the line. Verzenio is no walk in the park and the biggest side effect seems to be uncontrollable diarrhea often requiring one to modify one's normal daily routine. Major hit to one's quality of life. Ibrance does cause neutropenia but it is pretty tolerable other than that. I never feel any different/worse when my neutrophils are low (as compared to say low hemoglobin which causes anemia, which in turn causes intense fatigue, breathing issues, foggy headedness, etc. and sometimes requires red blood cell transfusions). The quality of life with Ibrance is relatively good compared to most other treatments. If your mom is experiencing noticeable side effects in how she is feeling physically, it is likely due to the letrozole. Neutropenia is an issue of infection risk as one's body may not have enough neutrophils to fight off a bacteria, virus or fungus that presents itself, which could require hospitalization for a dangerous infection. In my experience, when one's absolute neutrophil count (ANC) falls below 1,000 (sometimes presented as 10.0), it is like a yellow warning flag requiring close monitoring by the MO, and when it falls below 500 (.500), it is like a red flag and considered unsafe.
Some local treatments are only available to persons with limited tumor involvement whereas for other local treatments, it does not matter or they are indicated for higher volume of liver mets. I had Y90 radioembolization using SIR spheres and I have a heavy tumor load in my liver as well as diffuse liver mets. It is common for medical oncologists (MOs) to shrug off or disagree with a patient pursuing local treatment. My MO said no to Y90 for 6 months, until he learned more about the procedure. He is a big supporter now. Many of the liver local treatments are relatively new to breast cancer and most MOs aren't well enough informed about them. Also, MO's are trained to treat cancer with systemic medication so it is not too surprising that some of them aren't jazzed about a local therapy performed by an interventional radiologist (IR). It is outside their wheelhouse. I sought out and consulted an IR on my own to assess whether I was a candidate for Y90. Good luck with your mom. I have been living with high volume liver mets on what is coming up on 5 years this month.
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First of all, thank you so much for your reply!
I will talk to my mom about lowering her dosage then. I am just a bit scared since there is no evidence that lowering the dosage to 75 is still as effective as 100 or 125.
When do you think is a good idea to pursue local treatment? I have read that Y90 have a lot of side effects as well.
My idea was to destroy as many as possible while Ibrance still works because then once it stopps working, they would need to grow again and this would take longer than if they were already there and hence, this would give my mother more time. Do you think this is a good strategy? Treating them locally from the beggining?
Have you had any other local treatments?
That is great I will definitely tell my mom! Good luck to you too!
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pinkpink I had my first set of y90's at the very beginning of my TX on IL. I had a lot of tumors in my liver with a high uptake. IL did not work on them. But, Y90s kept them inactive for 18 months. I continued to take IL during the y90s for my lung and chest mets.
So, I am in support of local treatment along with systematic treatment. Only an IR who is experienced in y90 can evaluate to see if she is a candidate. Research and get a consult, regardless of what the MO says.
I'm now into my second set of y90. I'm 3 years out. Some mets that could not be seen in 2017, have grown. Three TX have failed to slow them down. So, I consulted my IR. I had the right lobe done two weeks ago, the left lobe will be done in two weeks.
I won't know the results for a few months but I'm hopeful to get more time.
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Grannax2,
thank you for your reply!
I will definitely research and contact a specialist. These two post have helped me a lot.
I wish you the best of luck!
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Hello again,
I just wanted to ask if there is anyone here that has recieved abemaciclib after developing a resistance for palbociclib. I found a paper in which it said that it may work for some people.
Also for the people taking abemaciclib instead of palbociclib: Why is this so? What reasons did your MO give? Or did you do deciede on your own?
Thank you in advance!
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You might want to post on the liver mets thread with this question pinkpink. I don’t know if there’s a thread for either of these TX , but you could start one if there’s not.
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There are threads for Ibrance (palbocicib) and Verzenio (abemaciclib). I would suspect some on the Verzenio thread have already cycled through Ibrance. A few come to mind offhand. May be the most productive to check there first.
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Thank you! I will
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