What's Going On with My Liver??

I went to my last oncology appointment feeling buoyant, energized by the pain relief I had finally gotten from the radiation to my shoulder blade and the news that my brain, eye, and pituitary tumors were all smaller, if only a little. I hadn't even taken anyone with me to my appointment; I was that sure I was getting good news.

And it was all good news until we got to my liver. Radiology reports are always hard to decipher, even with Dr. Google, but the gist seems to be that I have three new suspicious lesions in my liver. That alone wasn't enough to warrant changing treatment, according to my oncologist. They were initially going to recommend a higher dose of the treatment I was on, Xeloda.

Until they saw my liver enzymes. I get these checked every month to measure my liver function. They've been slightly elevated for a number of months, but this month they were super high.

Apparently, these enzymes enter the bloodstream when liver cells are damaged or have died, so to my oncologist, this was a clear indication that my treatment isn't working on my liver, and makes the inconclusive radiology report on the new lesions lean heavily to new cancerous spots. And since the liver is the biggest organ in your body (besides your skin), you kind of have to pay attention to it. Even more than the brain.

But just to make things more confusing, at least to me, my tumor markers (CA 15-3) have dropped back into the normal range. This test measures how much cancer antigen is being released into your bloodstream, and for the most part, the more cancer present, the more antigen it releases. It had steadily been climbing over the past year but had finally started coming down after I started Xeloda. And this month, it was down to the normal range.

But the liver enzymes seem to trump the other more positive findings, although I'm still hopeful these results are somehow a false positive. I feel so good on this treatment now that my pain is under control and I've adjusted to the drug. What's a little fatigue and hand-foot syndrome when faced with chemo? And the average response time to Xeloda is 18 months, with some patients getting 2-3 years. How can I only be getting 2-3 months? I was really looking forward to a treatment working for years again (Ibrance, I miss you!). 

They did agree to retest my liver enzymes before I start a new treatment. But the new treatment options depend on my HER2 status. Some cancers give off more of this, and there are targeted treatments that exploit this. My cancer was initially tested as hormone receptor positive (HR+), HER2 negative. All of the treatments I've been on so far are targeted for being HR+. But recently, a drug that targets HER2 positive tumors was found to work on patients who had previously tested negative but still had a low expression of HER2, now referred to as HER2-low. So they need to biopsy my liver to see if my tumors are HER2-low. Apparently, over 60% of patients who previously tested negative do have at least a little expression of HER2, and this new drug, Enhertu, is working for them. It's another drug, like Ibrance, that was so promising in clinical trials that the FDA fast-tracked it for approval.

The hope is that tomorrow's biopsy will show that I am HER2-low. However, the biopsy has to be sent off for analysis, and the results take 1-2 weeks to come back. Since it took so long to get the biopsy scheduled and since it will take a while for the results to come back, I asked to go back on Xeloda in the meantime, to keep my other tumors stable, if possible. 

I wasn't prepared for how scary it would be to be off treatment and in limbo, not knowing when the biopsy would happen, what the results would be, and what my future will look like. I have to keep reminding myself that my hope is not in the next treatment - it's in Christ. My days are in His hands regardless of biopsies and treatment options. I know I'll be healed - either here for a time, but definitely when all things are made new and life begins without pain, tears, or death.

Then I saw a new heaven and a new earth, for the first heaven and the first earth had passed away, and there was no longer any sea. I saw the Holy City, the new Jerusalem, coming down out of heaven from God, prepared as a bride beautifully dressed for her husband. And I heard a loud voice from the throne saying, “Look! God’s dwelling place is now among the people, and he will dwell with them. They will be his people, and God himself will be with them and be their God. ‘He will wipe every tear from their eyes. There will be no more death’ or mourning or crying or pain, for the old order of things has passed away.”

He who was seated on the throne said, “I am making everything new!”

(Revelation 21:1-5)

What a day, glorious day, that will be! Oh, for grace to trust Him more until my faith becomes sight.