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Liver lesions not responding to chemo, now what?

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  • Liver lesions not responding to chemo, now what?

    Hoping to get some input from people who have had liver involvement that did not respond to chemo. My husband is currently in 2nd line chemo, starting his 4th cycle of VeIP next week. After doing BEP over the summer the liver lesions had not improved and were possibly a bit worse. So a liver biopsy was done to determine exactly what was going on there. The report came back that it was necrosis, so they told us no cancer in the liver. Eventually we went onto 2nd line chemo because the cancer in the abdomen and lungs had not responded well to treatment and HCG went back up by an alarming amount. New scans were done immediately before the first dose so we could track exactly how it was working. This showed the liver lesions had all grown during the two months that had passed since the post BEP scans. Obviously the biopsy missed something. After the second cycle of VeIP they did new scans to see if this chemo was working. Good news was the lungs showed impressive results but the liver was, once again, worse.
    Since chemo is obviously NOT working for the liver, we need to decide how else to address it, whether that is radiation or RFA or some other form of treatment. The oncologist was confident we can do something, because as he says "we can torture your liver, but we need to be sure we're choosing the RIGHT torture so we get results." So they delayed the start of the third cycle a by a week so we could do another liver biopsy, this time with a different doctor doing the procedure at a different hospital with different pathologists. I was able to speak with the doctor before hand and he listened to my concerns about the first biopsy. He reveiwed all the older scans and compared them to the current ones to see what had changed, and also reviewed all the reports and talked to the oncologist. He said all the lesions looked the same, but that the centers looked different than the outer parts, so he suspected that there might be some necrosis in the center, which would explain the previous results, and made an effort to get good samples from both the center and the outer parts so we could hopefully get better results. Results are in... and are no different than before. We would LOVE to believe that these results are accurate, but since each new scan shows growth, they can't be. SOMETHING is going on there. The original pathology from diagnosis isn't helpful either, we started with a biopsy of the big abdominal tumor because that was discovered first. Those results were "poorly differentiated carcinoma". Later it was reviewed by a different hospital and they determined it was urological in origin and they did more tests and an ultrasound and that's how we found out what it was. HCG was 85,000 at the time, LDH a bit high. The pathology from the orchiectomy was that there was definitely teratoma, but they could not determine what else. Tomorrow they are going to do another biopsy of the abdominal mass, since it has barely responded to the current chemo and is easier to access than the liver and big enough that they can take a lot more samples. Hopefully they can finally determine the exact type of testicular cancer, but I'm not holding my breath.

    Given that the ONLY thing clear in any of the pathology reports was teratoma, we could very well be dealing with more of that, although HCG is still high, but that could be coming from what little is left in the lungs, so we can't be sure. Hopefully the lungs are clear after this next round and then if tumor markers are still up we'll have a better idea about the rest. So, my question for those who have had liver involvement that did not respond to chemo, what did you do? We will of course be traveling soon and getting more expert input after this last round of chemo, so I'm sure we will be given useful info, but it would be great to go in armed with the information that comes from the personal experiences of others.

  • #2
    It's incredibly frustrating not to know exactly what's going on. I'm sorry you're both dealing with all this and trust others on this forum have some practical advice for you.

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    • #3
      Is your husband being seen by the team at Dana Farber now or who is overseeing his care? This is certainly a situation, that if it were me, I would want to run past Dr Einhorn, perhaps Memorial Sloan Kettering as well. Basically, high volume centers that have seen many cases with liver involvement. Have you considered a second pathology review at Indiana as well? Honestly, I am not sure what the best steps are.

      I wish they had better answers for you as I know the unknown can be the most frustrating and scary

      Mike
      Oct. 2005 felt lump but waited over 7 months.
      06.15.06 "You have Cancer"
      06.26.06 Left I/O
      06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
      06.30.06 It's Official - Stage I Seminoma
      Surveillance...
      Founded the Testicular Cancer Society
      6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

      For some reason I do not get notices of private messages on here so please feel free to email me directly at mike@tc-cancer.com if you would like to chat privately so as to avoid any delays.

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      • #4
        Hi metcwife,

        the cancer seems to be chemo responsive to some extent. (necrosis, some lesions smaller etc).

        Knowing this, and seeing the possible feature with VIP I would suggest High-dose chemo - i think Einhorn would recommend this too - please reach out to him .. this case is special.

        I know i could not help much.



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        • #5
          We have not yet made the switch to Dana Farber, we were planning to do that after chemo since Dr Eihnhorn did say 4 VeIP without high dose was a reasonable treatment (although he would personally have done just one VeIP followed by the high dose). Our plan after this last cycle is to get new scans and markers, then head for Dana Farber, since we have NOT been happy with MGH (every thing we've had done here in Maine has been awesome though!). The nurse is planning to get the referral going for us as soon as the new insurance plan kicks in next week. We're expecting the lungs to be looking pretty good since the mid point scans showed so much improvement, and the abdominal mass can be surgically removed, so really it's mostly the liver we're concerned with at the moment. I did find out this morning when we went for the new biopsy that that abdominal mass is NOT very vascular and doesn't appear to have a good blood supply. That made it easy for them to get multiple samples so hopefully we get some good info that i can take along to Boston.

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