Liver mets: resection, ablation, SBRT, Y-90, anything else?
Comments
-
Shetland..well about damn time your persistent liver met was addressed. Good for you.
0 -
Hello ladies - I am an infrequent poster, but frequent reader of this and other threads. I have lung, bone (including dural) and liver mets. I've been on basically all the hormonal & targeted therapies (including piqray where I had a terrible reaction). These therapies have generally kept the lung & bone in check although there has been progression. Like many of you, it's the liver mets that aren't responding. The only chemo I have been on so far is Xeloda. I just completed 3 cycles and my liver mets progressed quite a bit during that time. My next logical stop is IV Taxol. In Canada, Y90 is rarely done for breast cancer, but it is a possibility.
My question for you ... would you think it is best to do one IV chemo and see how I respond and save Y90? Or, based on your experience would you just go straight to Y90? I appreciate any advice you have. These decisions are terribly difficult.
0 -
Sandibeach. I asked him if there was a lifetime maximum of yttrium, he said yes. I asked if i could have a third one, he said we might have a little wiggle room. So, I don't have a firm answer for you. I guess it depends on how many tumors/ how much ittrium needs to be used for your procedure.
Sary. I did try another chemo before I had my second set of y90s. It was Gemzar and Carboplatin. It failed, but that doesn't mean that it would fail for you. Based on my exam, I think it would be wise for you to research an IR and get a consultation with him. But, will you need to come to the U.S. for a consultation? Also, there are chemotherapies that be taken even during y90s.
The hard part is finding an MO and IR very familiar with the success of y90s for MBC. Even in the U$, some are not knowledgeable. Do your research. Let us know what you decide. 💞
0 -
My AVF embolization was done yesterday. I found out that they blocked the fistula by inserting coils. He was able to look at my mets on the CT used for this procedure. He said the blood vessels looked better. Evidently, they were more enlarged when they were feeding all the tumors, now they are smaller. That sounds good to me. The tumors look smaller, too. Yay y90!💞
0 -
Grannax congratulations on the results of Y90...may you continue to benefit for many years to come! Yahoo for Grannax the queen of Y90!
0 -
Terrific news Grannax! How are you feeling?
I did find out that I will have a bland embolization to quadrant IVb at the same time as Y-90 to the tumors in the right lobe. Yay. All done at once. Coming in 2 weeks.
Did any of you on Y-90 get a script for a Medrol steroid pac to help with the fatigue or a script for nexium/protonix to help avoid stomach ulcers.
I read the MDA education paper on Y-90 and it said they may prescribe these.
Dee
0 -
Dee, yes, I did receive a prescription for a steroid pac. I took it and am glad I did. I usually refuse/avoid steroids with treatment at all costs. It does just what you note - helps immensely with fatigue and also helps prevent stomach ulcers. I found myself having large amounts of energy a day or two after the procedure for the entire course of the steroid pac. I worked from home starting the day after my procedure and was working like a machine during that time, pretty much straight through the day for 10-11 hours with minimal breaks. It was a bit shocking. I was very productive with work and other matters around the house. Once the steroid pac was over, I did have a big dip in energy for a few weeks with the right lobe. With the left lobe, there were much less side effects because it is so much smaller and probably because I knew what to expect the second time around.
Sary, there is no right or wrong way to time Y90. You should speak to your MO about systemic treatment options and also have an IR consult about Y90. I did do one chemo before I had my Y90 and then had the Y90 after that. I know Grannax had her first Y90 pretty early on. After speaking with both doctors, you may start to get a sense of what is right for you and what you want to do. I think you will find pretty much any chemo you try much more tolerable than Piqray. Calling it a "targeted" therapy is misleading in that respect. The side effects are horrendous for most. I was choosing between Piqray and my current chemo, Gemzar, a few months ago. My MO told me that the side effects of Piqray are much more harsh than Gemzar. Not sure if you care but not all IV chemos cause hair loss - (like Xeloda) Doxil, Navelbine and Gemzar do not typically cause any hair loss and I didn't lose any hair on those. All 3 were/are very tolerable.
Shetland, sounds like you have a great plan with Y90! Good that you know the cause of the bile stricture now. Scar tissue, wow. Did your doctor say there is any rhyme or reason as to why you developed scar tissue? I know it happens but don't know whether there are any ways to reduce the risk of developing it.
0 -
Grannax2, whenever I do a new treatment, starting from #1, I point at the mets in my liver and command, “Die, Suckers, Die!”
My Y90 will be in about three weeks. First they want me a week out from stent exchange (recovering now) with no fevers. Then we do mapping. Then IR is gone for a week (noooo!). Then we do Y90.
BevJen, it’s crazy how I need a breast cancer team and a GI team. I feel so lucky to have these people to help me. The endoscopy guru keeps me alive with these every-three-month stent exchanges. That more than anything else makes me feel like a stage iv cancer patient.
0 -
Frisky. Thanks for my new nickname. Love it. I'm waiting for someone else to have their second round ( JFL) so there can be two queens.
Alabama Dee. I'm feeling great. I was on a steroid high yesterday because they have to give me IV steroids because I'm allergic to iodine contrast for CT. Yes, I got about five RX after y90 but only needed one. It's the one that coats your stomach. I had some stomach pain after my right lobe y90. Bland embolization makes perfect sense. Glad you're getting both done at once.
Shetland. YES. Death to liver monsters. Glad your team has you set up to get your y90's. 💞
0 -
Thanks for the input. I am feeling the need to get going on treatment (as does my MO), so I am starting Paclitaxel on Monday. My MO feels strongly that this is the right next step. In the meantime I am going to get a referral to talk to the IR and will hopefully be able to do Y90 in the future (either pause chemo or do it after this chemo stops working). I really appreciate reading about everyone's experience. I would not even have known to ask about this treatment if not for this community.
0 -
scary- paxliaxol ook care of my liver Mets in after progression. Best wishes.
0 -
JFL, that's a good question, why did I develop such scar tissue and is there any way to avoid it. For some reason I think some people's bodies tend to develop it more than others but I really don't know. I do know that my first treatment for mets, Taxol, worked very fast on a very large amount of tumor; and that when I started Xeloda, it also worked extremely fast. I wonder if this speed made it more difficult for things to heal smoothly. Because the reason the liver/biliary specialist preferred Y90 to ablation was that the speed of ablation would make scar tissue more likely, and scar tissue can be a nest for bacteria — a particular concern with my biliary stents. The endoscopic ultrasound report seemed to describe so much inflammation and scar tissue that I became concerned about the rare autoimmune diseases primary sclerosing cholangitis and primary biliary cholangitis, but the specialist categorically said I do not have those.
Yup, Sandi. When I emailed my onc after the scan that showed Doxil hadn't shrunk that met, to tell her I wanted to zap it, she did not hesitate to say, “I agree!"
0 -
Now I am getting nervous and craving information as an antidote.
Can anyone give me a blow-by-blow of what happens on mapping day, the preparation and procedure? Cautions and tips (but not horror stories)?
Same for Y90 day.
0 -
Shetland Pony
This is the link to my education paper. hope it helps
I as m not a good one to compare to - I did it unsedated my after procedure mapping issues were arthritis back pain (From bing off my NSAID) and headache (from lying still, no caffeine and fluids) I had fentanyl and Tylenol and they pushed some iv fluids then I got d sad one coffee and I recovered fineDee
0 -
Thank you for that link, Dee. It was helpful.
0 -
shetlandpony
one thing they don’t mention is 2 hours of lying still after the procedure- can’t bend the leg or move the hip and only raise your head 30 degrees so the blood clot will form in the artery. had to use a bedpan 🥴BTW I like your name I had a Shetland/welsh mix pony as a kid. It’s name was Dynamite 🐴
Dee
0 -
See, this is why it’s so valuable to talk to other patients.
I bet Dynamite was adorable! How tall?
0 -
Shetland. My IR used the brachial artery in my wrist this time. It was so much easier for me. Do you know which way yours will be done? They put a gadget on my wrist that applies pressure. The nurse takes air out every 15 minutes. They tell you not to use your hand and arm while in recovery. Then when all the air is out, they take the gadget off and put on a disposable wrist brace. I had to wear it for 24 hours. Also there are restrictions about lifting. Only four pounds for five days. The great thing is that my arm did not hurt at all. Technology is always improving.💞
0 -
grannax. I wish I could use the arm but it has Lymphadema. The vascular surgeon used my left arm to do an angioplasty to clear the subclavian DVT. medical wonders!Scans, plans and y-90 procedure starting Monday. Will update.
Shetland pony- Dynamite was taller than a typical Shetland so we road her a long time in our family before progressing to horses. My sister road her so much that she did not need a bridle. She would just run up behind the pony and hop on and go.
Speaking of horses- I have a new mantra. “make the best of each day for the gift it is!” So before the medical stuff at MDA next week we are spending some time in Galveston with my daughter and SIL and plan to ride horses on the beach!
In it to win it!
0 -
Alabama Dee. I'm so jealous. I owned and raised horses for ten years. Riding was my happy place. But, I never got to ride them on a beach. Send pics.
I was much much younger when I had my horses, my 20's. Seems like a lifetime ago and just yesterday in some ways. I'm 72 and have not ridden in awhile. But, still love everything about horses. Have fun. You too, Shetland.💞
0 -
Is there anything out there that's fairly recent that lists the various local procedures for liver Mets (Resection, Y90, SBRT, ablation, etc. Etc.) and under what circumstances one treatment would be used instead of another.
Personal anecdotes are welcome. For instance, ER,PR, HER2, how many and how large were the Mets, how long between diagnosis and procedure, what medicine (AI, chemo, rad, etc. Were you on before and after the procedure, and how long? Anything you want to add.
Thank you.
0 -
It is likely in Best Bird's book, which is available complementary. There is a thread pinned in this forum on how to obtain one.
0 -
Interesting post on the feed I subscribe to from the National Cancer Institute about the "abscopal effect" -- the article focuses on proton therapy, but is applicable as well to other types of local treatments. Worth a read.
https://www.cancer.gov/news-events/cancer-currents...
Bev
0 -
Bev Jen, I remember when Z would write about this ( still miss her). I have to admit I never did understand it. It was way too much for my 72 year old brain. LOL it might be in Best bird's book.
0 -
Got my Y-90 and bland embolization last week. Feeling better than expected. It helps I got a Medrol pack. 😉 just feeling some liver area and groin discomfort along with slight fatigue
procedure was fine, but in recovery my blood pressure spiked and the pain was hard to control from the bland embolization so I spent the night in the hospital. Flew home and doing laundry today. 💪🏻 I am behaving with the lifting restrictions- had to cancel watching my granddaughter this week 😢
The bad news is Doxil did not work. 2 liver tumors grew 5 mm and one doubled to 4 cm. I now have spots in my lungs suspect for metastasis. This is my 3rd line in 9 months. Grrr😠
so I found a clinical trial in Nashville for a drug that has a fast track from the FDA. I have the esr1 mutation so hopefully this one can help. If I don’t qualify then I will do afinitor and faslodex next. https://www.targetedonc.com/news/fda-grants-fast-track-designation-to-lasofoxifene-for-er-esr1mutant-metastatic-breast-cancer
MD Anderson has no clinical trials for me until I run out of lines. 😕
I finish my last doxil on Friday if my liver enzymes are good.
I made the most of the trip to Houston and spent a day with daughter and SIL, rode Horses on the beach, visited the long horn museum and natural science museum, ate out well and rested in a nice room. Each day is a gift!!
Dee
0 -
Dee. Thank goodness you got your y90. I'm sad about Doxil not working, but hopeful about the ESR1 trial. I'm going to read the info you posted.💞
0 -
Dee is there a trial number? I read the article, it sound promising but too far away for me.
0 -
grannax
yes,so glad I got y-90!
Do you have the esr1 mutation?
NCT03781063 The trial has many sights- maybe one near youHad myself a good cry this morning.It is a little overwhelming that I have to do all the research to find trials for myself.
MDA doc will look in her realm but not outside. Local MO I've had for the last almost 7 years seems to just do what I need for chemo and bloodwork but not looking on his own to help me.
Looking into more Neuroendocrine therapy since Tumors have somatistatin receptors. Excel in Houston may have an off label for Lutathera but it is not covered by insurance. $11,000 per treatment ( x4) plus travel and lodging. But Hubby said if that's what it takes we will do it. They are checking to see if Neuroendocrine breast cancer will qualify.
One day at a time!
Dee
0 -
Dee, that’s the oral faslodex drug! I offered to do anything to get that instead of the shots in my upcoming trial — say, give up my firstborn child — but they said No.
Grannax2, don’t shoot me. The Y90 was cancelled. The day before, I was emailing with my Onc, and I found out that my Onc, the IR, and I each had a different target in mind. Onc thought we were zapping a tumor causing the bile duct stricture. But we can’t detect an active tumor there. IR thought we were zapping a tumor that was causing me pain. But that was a different tumor and I don’t currently have pain. I thought we were going to zap two mutant rogues that were not responding to chemos. But IR only wanted to do one because of fear of infection. (My stent raises my risk.) So my onc said I could do it, but why put me through it when we would put out a fire in the bathroom while the whole house was on fire. Sooo, I am just proceeding with the trial. If things get bad, I may say infection risk be damned, zap them all. In other words if the risk vs. benefit analysis changes. I don’t know what they will say. I wish I had done this before I needed the stent. But how could we know?
0 -
Shetland...reading your update put a smile on my face. I’m so glad you don’t have to undergo any treatments on your liver right now...I had such a dark presentments but I didn’t want to affect your decision in any way....
Thank Goodness your team woke up on time...
0
