HAI Pump Therapy

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mom_2_3
mom_2_3 Member Posts: 953 Member
edited March 2014 in Colorectal Cancer #1
When I was first diagnosed with Stage IV colon cancer with 5 mets to the liver I was told by an oncologist at our local cancer center that I was inoperable. That oncologist recommended 6 rounds (12 treatments) of FOLFOX/Avastin and said we would scan in 6 months.

I sought a second opinion from Memorial-Sloan Kettering in NYC. I was told there that I was "close" to resection but they wanted me to do 2 rounds (4 treatments of FOLFOX) and then scan to see where I was at the 2 month mark. I was told that if I had a good response I would keep on the FOLFOX until operable. Or, if the cancer progressed then they would do the colon resection and implant something called an HAI pump. This pump directs chemo right to the liver over a 2 week period and is used with systemic chemo.

At the 2 month scan my mets had decreased 40% in the liver and I was told at my consult with the liver surgery that I would be going into surgery 11 days later. Talk about whiplash... As part of that surgery I would have the colon resected, the liver resected, my gallbladder removed and the HAI pump implanted for adjuvant therapy. I had the surgery 2/20 and was declared NED and have had 2 NED scans since then.

Part of my therapy is to receive chemo in the HAI pump every 5 weeks. My schedule for chemo is like this:

Day 1: HAI chemo
Day 15: Systemic chemo
Day 28: Systemic chemo
Day 35: HAI chemo
Day 49: Systemic chemo
Day 63: Systemic chemo

So every 5 weeks I receive 2 systemic and 1 HAI chemo treatments. The HAI treatments are painless and there are no side effects at all. My oncologist is the "queen" of this particular treatment and monitors liver enzymes very closely to ensure that the liver is not over-taxed by the chemo.

After 6 months of this schedule I will stop active treatment and go into the scan/wait/PRAY mode. I will also start on my supplements and increase my juicing.

The reason I posted this is because there are a number of new people on the board with liver involvement in different stages. The HAI pump can be used as pre-surgery treatment (to get an individual to resection) or as an adjuvant therapy (to be used to kill the microscopic cells and prevent new tumors in the liver). My oncologist just published a new paper in April (I think) 2009 at the oncologist's meeting and presented her paper about the success of this treatment to getting individuals to resection.

If you have not yet investigated this type of treatment you may want to. I have met people in the waiting room at the oncologist's office who are having/have had tremendous response to this treatment. I met one man who had 15 mets and after 1 year was down to 1 and preparing for liver resection. They will occassionally do this treatment if one has lung involvment as well. When I asked the first surgical oncologist I met (local center) about this treatment he said it was no good and Avastin was best route to do (but, if I really wanted it he would put one in me...um, no thanks...). We were very fortunate that I was able to go to MSK and find a doctor that would be as aggressive in my treatment as I wanted to be.

So if you are in the position of having liver involvment please google HAI or Hepatic arterial infusion pump and research this option. If you can travel to NYC there is a Hope Lodge that provides free lodging to thos having treatment. I recommended this treatment to someone else I met online and she and her husband are preparing to return home to Texas after getting an HAI pump implanted. They stayed at the Hope Lodge for 5 weeks for free. There are also flight services that will fly you for free. So there are ways to deal with the finances of travel. Once the pump is in you would travel to NYC every 5 weeks for treatment and receive the systemic treatment at your local oncologist (with the NYC oncologist overseeing your treatment).

If anyone has any questions please post. I know there are a couple of others on the board that have had this same treatment and I'm sure all can vouch for the intelligence and acumen of the NYC oncologist that we are patients of.

Amy

Comments

  • PhillieG
    PhillieG Member Posts: 4,866 Member
    #2
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    Hi Amy
    I think we already had this conversation but your news sounds very good. I know the "queen" of whom you speak. She's great! I still have my pump in me after 5 years, I only get it refilled with gylcerol now which keeps it primed. I have to have that done every 8 weeks. My liver has been fine since my operation and follow up treatment. She, and her staff, are amazing. I just got a form I had to fill out from Codman (?) the company that makes the pumps. I guess there's a deposit on it or something and they wanted to know if it's still in use and who refills it yada, yada, yada. I'm still waiting for a metal detector to go off because of it.
    -phil
  • Paula G.
    Paula G. Member Posts: 596
    #3
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    PhillieG said:

    Hi Amy
    I think we already had this conversation but your news sounds very good. I know the "queen" of whom you speak. She's great! I still have my pump in me after 5 years, I only get it refilled with gylcerol now which keeps it primed. I have to have that done every 8 weeks. My liver has been fine since my operation and follow up treatment. She, and her staff, are amazing. I just got a form I had to fill out from Codman (?) the company that makes the pumps. I guess there's a deposit on it or something and they wanted to know if it's still in use and who refills it yada, yada, yada. I'm still waiting for a metal detector to go off because of it.
    -phil

    Hello Amy
    This is great news and great information. Thanks for sharing it. And good luck to you!
    Paula G.
  • ADKer
    ADKer Member Posts: 147
    #4
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    Paula G. said:

    Hello Amy
    This is great news and great information. Thanks for sharing it. And good luck to you!
    Paula G.

    HAI pump therapy
    I also have an HAI pump and believe that it has been tremendously helpful to me. At diagnosis, I had extensive liver mets spread throughout my liver. I was very fortunate to consult with a local surgeon who referred me to Amy's doctor at Sloan-Kettering. The local surgeon had previously treated a gentleman who was 3+ years NED after treatment for Stage IV CRC at Sloan-Kettering. A PET scan showed only liver metastasis, although it is possible that I had tiny lung mets too small to light up on the PET scan. With only liver metastasis, I was eligible for an HAI pump, which was implanted during my colon resection surgery. I received a very aggressive chemo regimen - oxaliplatin and irinotecan plus FUDR(a potent form of 5-FU) directly to my liver through the HAI pump. I had a dramatic response to the chemo, with my CEA falling from 6955 when I began chemo to 21 prior to liver resection 6 months later.

    I believe that the HAI pump, in addition to shrinking my liver mets, has also had a significant impact on my quality of life. My side effects from the oxaliplatin and irinotecan were the usual - neuropathy, diarrhea - to a moderate degree, but I did not experience the significant fatigue that appears to accompany systemic 5-FU. As a result, I was able to exercise and feel very good.

    My path after liver resection has not been as smooth as Amy's but I believe that my disease was more extensive at diagnosis. During the time that I was off of chemo for liver resection, several small lung nodules became apparent. I took Xeloda for the lung nodules for 4 months, which kept them stable, but a liver met developed in the caudate lobe of my liver, which was not part of the earlier liver resection. When the liver met appeared, my chemo regimen was switched back to HAI pump therapy and irinotecan. After 16 weeks, the liver tumor cannot be found and we are not back to focusing on the tiny lung mets.

    The HAI pump requires significant experience from the surgeon who installs it in order to avoid complications. It also requires significant experience and expertise from the oncologist to avoid liver damage. In the hands of an inexperienced doctor, I believe that the HAI pump could be dangerous. However, with an oncologist experienced with the HAI pump, I believe that it can be tremendously effective.
  • dmdwins
    dmdwins Member Posts: 454 Member
    #5
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    ADKer said:

    HAI pump therapy
    I also have an HAI pump and believe that it has been tremendously helpful to me. At diagnosis, I had extensive liver mets spread throughout my liver. I was very fortunate to consult with a local surgeon who referred me to Amy's doctor at Sloan-Kettering. The local surgeon had previously treated a gentleman who was 3+ years NED after treatment for Stage IV CRC at Sloan-Kettering. A PET scan showed only liver metastasis, although it is possible that I had tiny lung mets too small to light up on the PET scan. With only liver metastasis, I was eligible for an HAI pump, which was implanted during my colon resection surgery. I received a very aggressive chemo regimen - oxaliplatin and irinotecan plus FUDR(a potent form of 5-FU) directly to my liver through the HAI pump. I had a dramatic response to the chemo, with my CEA falling from 6955 when I began chemo to 21 prior to liver resection 6 months later.

    I believe that the HAI pump, in addition to shrinking my liver mets, has also had a significant impact on my quality of life. My side effects from the oxaliplatin and irinotecan were the usual - neuropathy, diarrhea - to a moderate degree, but I did not experience the significant fatigue that appears to accompany systemic 5-FU. As a result, I was able to exercise and feel very good.

    My path after liver resection has not been as smooth as Amy's but I believe that my disease was more extensive at diagnosis. During the time that I was off of chemo for liver resection, several small lung nodules became apparent. I took Xeloda for the lung nodules for 4 months, which kept them stable, but a liver met developed in the caudate lobe of my liver, which was not part of the earlier liver resection. When the liver met appeared, my chemo regimen was switched back to HAI pump therapy and irinotecan. After 16 weeks, the liver tumor cannot be found and we are not back to focusing on the tiny lung mets.

    The HAI pump requires significant experience from the surgeon who installs it in order to avoid complications. It also requires significant experience and expertise from the oncologist to avoid liver damage. In the hands of an inexperienced doctor, I believe that the HAI pump could be dangerous. However, with an oncologist experienced with the HAI pump, I believe that it can be tremendously effective.

    Info
    Thank you all for the information and sharing your experiences. I am always interested in knowing what treatments have been sucessful should I need to explore those options in the future. NYC seems to be the place to go!

    Dawn
  • SSmith25
    SSmith25 Member Posts: 11
    #6
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    Hi Amy:
    Same hospital, same
    Hi Amy:

    Same hospital, same treatment routine, not same doctor, but I was part of her trial. 4.5 years cancer free. I was told I had only a few months when I was diagnosed.

    Congratulations! We are among the lucky ones. Thanks for putting out the word.
  • SSmith25
    SSmith25 Member Posts: 11
    #7
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    pump removal
    PS They removed my pump after 2 years because I am relatively young and active, and I really wanted it out. Once out, however, a new one can't be reinserted, but I took the option. If I have a reocurrance, I'm counting on the quickly advancing field to have new protocols. I'm just hoping I don't have to cross that bridge.
  • mom_2_3
    mom_2_3 Member Posts: 953 Member
    #8
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    SSmith25 said:

    Hi Amy:
    Same hospital, same
    Hi Amy:

    Same hospital, same treatment routine, not same doctor, but I was part of her trial. 4.5 years cancer free. I was told I had only a few months when I was diagnosed.

    Congratulations! We are among the lucky ones. Thanks for putting out the word.

    Hi!
    Great news! I keep a list of long-term survivors and I am very happy to add you to my list!! I am very happy for you!

    I figure if all goes well I will keep the pump in for 4 years or so. It doesn't bother me other than sticking out a bit on one side but after 3 kids my stomach isn't going to be perfect anyway!!

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