Liver cancer: Doctor said: “Don’t take Nexavar!”

In my earlier posting, I wrote about one “rotten” morning I experienced. Now, let me share with you what a “weird or cuckoo” morning was like.

AKS is a 57-year-old Indonesia. His problem started with a fever a few months ago. He went to a hospital in Jakarta for help. He was told nothing was wrong with him.

AKS was not satisfied and consulted another doctor — an internist. Again he was told there was nothing wrong with him. Still not satisfied, he consulted a stomach specialist. He was told something was in his liver!

AKS came to a private hospital in Penang for further consultation in February 2018. He saw one doctor and did an endoscopy. The result indicated esophageal varices, gastritis. Negative for Helicobacter pylori. 

A CT scan was done and showed the following:

  • Coarse liver parenchyma suggestive of underlying cirrhosis.
  • Ill-defined mass in the right lobe of liver measuring 10.5 x 9.5 x 7.8 cm.
  • Smaller lesions scattered in both lobes of liver ranging from 1.0 to 3.5 cm in size.
  • Features suggestive of multicentric hepatoma.
  • Mild ascites.

Blood test results were as follows:

Alkaline phosphatase 198 H
GGT 178 H
ALT   63 H
AST 112 H
Alpha-fetoprotein 354.4

AKS was told to undergo a procedure called TACE (transarterial chemoembolization). He refused and went home to Jakarta.

In March 2018, AKS came back to Penang again. This time, he consulted an oncologist in another hospital.

His blood test showed deteriorating liver function.

Alkaline phosphatase 249 H
GGT 323 H
ALT   60 H
AST 143 H
Alpha-fetoprotein 617.7

AKS was prescribed Lenvima (or Lenvatinib). For 20 days the drug cost him RM5,000. The doctor said this drug would not cure him!

I asked AKS. The doctor did not ask you to take Nexavar? His reply, The doctor told me not to take Nexavar!

AKS took Lenvima for two days and felt nauseous and dizzy (as before). He and his family decided to seek our help.

Comments

  1. AKS went to see two doctors. They couldn’t find anything wrong. The third doctor said there was something in this liver. Then he came to Penang and the first thing the doctor did was endoscopy! But there was something in his liver? Why endoscopy? Is this procedure just a matter of routine? More procedures better?

Do you think all these make sense? Ask again, do you really need an endoscopy?

  1. As you can see, AKS went round and round, and only then a blood test and CT scan were done. Sure enough the results indicated tumours in his liver.
  1. AKS was asked to go for TACE. AKS refused.

For whatever treatment suggested, it would be wise if patients were to ask their doctors these questions:

  • What is this treatment for? Can cure you? Prolong life? Improve quality of life?
  • How much does the procedure cost?

There is a 10.5 x 9.5 x 7.8 cm tumour in his liver. In addition, there are smaller lesions scattered in both lobes of the liver ranging from 1.0 to 3.5 cm in size. Do you think TACE can help the patient? In what way?

Over the years, I have come across many patients who did TACE but did not benefit from this treatment.

  1. AKS was prescribed Lenvima (or Lenvatinib) for his liver cancer!

I have never heard of this drug before! I told AKS usually doctors would ask patients to take Nexavar. This was when I got a shocking reply. The doctor told AKS not to take Nexavar!

How could that be? What has happened? Does the doctor NOW know something about Nexavar that we all do not know?

For the past two months, I have liver patients coming to me and they were taking Nexavar — why the change of “heart”? There must be a reason for this change from the standard practice.

Let me say that those patients on Nexavar suffered severe side effects and gave up on the drug. That was why they came to us for help. I have written some cases about Nexavar and I am going to write more cases later.

There was one lady who paid RM 20,000 for a month supply of Nexavar. She was told that when she comes the next month, she will get one month supply of Nexavar for free (promotion — buy one, free one).  According to her son, after taking this drug for a week, she landed in the hospital and died.

So the question is, why was AKS told not to take Nexavar now? It is because of such experiences above or something else?

But  more tragedy to come. Instead of Nexavar, AKS was described Lenvima  or lenvatinib. I had to go into the net to find out what that is.

Lenvima, a drug made by Eisai Inc. was approved by US – FDA for the treatment of locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer.

Lenvima is also used in combination with the drug everolimus, for the treatment of advanced renal cell carcinoma.

Here are the side effects of Lenvima:

Less common side effects (occurring in about 10-29% of patients) are:

Source:

http://chemocare.com/chemotherapy/drug-info/lenvatinib.aspx

https://www.prnewswire.com/news-releases/fda-approves-eisais-lenvima-lenvatinib-for-the-treatment-of-patients-with-locally-recurrent-or-metastatic-progressive-radioactive-iodine-refractory-differentiated-thyroid-cancer-300036074.html

There is a fine note which says: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful. Is this not what is happening now? Liver patients is given a drug for thyroid or kidney cancer?

Its sounds like an “new experiment” on patients! Giving  a chemo-drug that is approved for the treatment of thyroid or kidney cancer to liver cancer patient … to see what happen?

I went cuckoo this morning! Oh, it is just a weird morning. My first time to learn such thing.

 

 

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