Does Cancer Treatment Drug Cause Elevated Liver Enzymes?

Does cancer treatment medication cause elevated liver enzymes?

Hello Doctor, my father was diagnosed with rectal cancer two years ago and underwent surgery, recovering well.
However, during a routine check-up two months ago, a recurrence was found, but the original treating physician indicated that the location of the recurrence was not suitable for surgery and referred him to the hematology-oncology department for chemotherapy.
Before starting treatment, his GOT/GPT levels were unexpectedly high at 220/586.
After three days of hospitalization and treatment, these levels dropped to 77/256, and the doctor then prescribed the self-paid chemotherapy drug Atezolizumab capsules.

Since then, his weekly blood tests for liver enzymes have consistently shown GOT/GPT levels around 1XX/3XX, until last month when he developed jaundice, along with noticeable fatigue, darkening of the face, and yellowing of the sclera.
Recently, his GOT/GPT levels increased to 4XX/4XX, and his bilirubin level was 15.4.
The doctor tested for hepatitis A and B, both of which were negative, and abdominal ultrasound examinations did not reveal any liver abnormalities, leaving us unable to determine the cause.
My father's condition has suddenly become very critical due to liver issues.

Initially, he was doing well during chemotherapy, but his condition deteriorated rapidly.
We later researched Atezolizumab capsules online and found that the drug's information states it is not suitable for patients with liver function abnormalities, and that it should be administered for 28 days followed by a 14-day break.
The doctor did not stop the medication but mentioned that the dosage had been reduced.
We are unsure if this means it is safe to continue without a break.

We are concerned that this chemotherapy drug may be affecting my father's liver.
What other options do we have at this point? Thank you very much, Doctor.

LHF, 20~29 year old female. Ask Date: 2021/07/06

Dr. Chen Shidian reply Gastroenterology and Hepatology

I have never used Esomeprazole capsules and my condition is complicated, so please discuss it further with my attending physician.

Reply Date: 2021/07/06

More Info

Elevated liver enzymes during cancer treatment, particularly with chemotherapy drugs, is a significant concern that requires careful management and monitoring. In your father's case, the use of the chemotherapy drug Atezolizumab (referred to as "愛斯萬膠囊" in your message) has raised questions about its impact on liver function, especially given the history of elevated liver enzymes (GOT/GPT) and the recent onset of jaundice and other concerning symptoms.

Chemotherapy agents can indeed cause liver enzyme elevations due to their hepatotoxic effects. The liver is responsible for metabolizing many drugs, and when it is overwhelmed or damaged, it can lead to increased levels of enzymes like AST (GOT) and ALT (GPT) in the bloodstream. In your father's situation, the initial elevation of liver enzymes prior to starting chemotherapy, followed by a temporary decrease, and then a significant rise again, suggests that the liver may be struggling to cope with the treatment.

The symptoms of jaundice (yellowing of the skin and eyes), fatigue, and darkening of the skin are indicative of liver dysfunction. The fact that your father's bilirubin levels are elevated (15.4) further supports this concern. It is crucial to determine whether the chemotherapy drug is the primary cause of these liver issues, especially since the drug's prescribing information indicates it may not be suitable for patients with existing liver dysfunction.

In terms of management, it is essential to have an open dialogue with your father's oncologist. Here are some steps that may be considered:
1. Re-evaluation of Medication: Given the potential hepatotoxicity of Atezolizumab, it may be prudent to discuss the possibility of discontinuing this medication or switching to an alternative treatment that is less likely to affect liver function. The oncologist may consider the severity of liver enzyme elevation and the presence of jaundice when making this decision.

2. Liver Function Tests: Regular monitoring of liver function tests (LFTs) is vital. This includes not only AST and ALT but also bilirubin levels and alkaline phosphatase. These tests can help track the progression of liver dysfunction and guide treatment decisions.

3. Supportive Care: Depending on the severity of liver dysfunction, supportive measures may be necessary. This could include hydration, nutritional support, and possibly medications to manage symptoms associated with liver dysfunction.

4. Consultation with a Hepatologist: If liver function continues to decline or if the cause of liver enzyme elevation remains unclear, a referral to a liver specialist (hepatologist) may be warranted. They can provide additional insights and management strategies tailored to liver health.

5. Consideration of Alternative Therapies: If the current chemotherapy regimen is deemed too risky due to liver concerns, the oncologist may explore other treatment options, including different chemotherapy agents, targeted therapies, or immunotherapy that may have a more favorable safety profile regarding liver function.

6. Patient Education: It is essential for you and your family to understand the potential side effects of the medications being used and to be vigilant about any new symptoms that may arise. Keeping a detailed record of your father's symptoms and lab results can be helpful during consultations with healthcare providers.

In conclusion, elevated liver enzymes during cancer treatment is a complex issue that requires a multidisciplinary approach. Open communication with the healthcare team, regular monitoring, and a willingness to adjust treatment plans based on your father's liver function will be crucial in managing his overall health and treatment outcomes.

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