HAI Pump

fez1 · February 2009

Hi everyone,

My husband is the stage IV colon cancer survivor but he looks to me for all of his options and research etc. He has had recurrences in his liver over and over during the past 3 1/2 years. He's had 2 wedge resections, 2 RFA's, stereotactic radiation and of course, all of the chemo regimens (Folfox with Avastin, Folfiri, Erbitux). His last CT scan last week showed 2 new small mets in his liver while he was on Erbitux. So now he's not going to continue. Have any of you had the HAI pump? It was suggested to us by Dr. Fong at Sloan-Kettering in September '06. We had no interest in it because the research shows that it has no better result that systemic chemo. Sloan-Kettering always pushes the pump somewhat (It was started there). Anyway, lately on my web sites I've noticed more than a few people talking about how it was so successful for them. We are looking into SirSpheres but I'm having a nagging feeling about not trying this pump. Is there anyone out there who has anything to add??? Take care all

Carol

mom_2_3 · February 2009

Pump
Carol,

I can't comment too much on the HAI pump as I just had one installed on Friday (2-20). I am a patient at MSK. When we went initially to an oncologist at our local hospital (Morristown, NJ) we were told I would not be resectable (by the oncologist). We immediately headed over to MSK. Almost 3 months to the day after being told I was not resectable I had my liver resection and colon resection and implantation of the pump. I am currently recovering in the hospital.

What the MSK liver surgeon told us is that there is a 50% chance of recurrence in liver but with the pump the chance of recurrence would be 30%. I would take those odds any day. My husband asked why so many other oncologists were hesitant with the pump. In fact, our original oncologist called the pre-eminent oncologist as MSK the "pump lady" and he told us a study showed only 4 monmths added lifespan. Well, MSK does HAI chemo and systemic at the same time and that was not part of that study. Additionally, we are looking at the HAI pump as adjvuvant therapy as they were able to remove the entire left lobe of my liver and a wedge resection of my right (single tumor). In researching the pump I came across a number of people who were long-term NED survivors and many of them had had a liver pump.

Our liver surgeon said that any dr diagnosed with Stage IV to liver at MSK would have the pump. His comment about other oncologists that don't like it is that it is too much work. He felt many oncologists like to prescribe chemo and be done with it. Our first onco prescribed 6 months of FOLFOX and Avastin with a scan at 6 months. Our onco at MSK said FOLFOX only (didn't want Avastin to compromise healing) for 2 months and then a scan to determine which direction my mets were going. My mets luckily shrunk by about 50% by the 4th treatment. And our onco immediately referred me to surgery. What the liver surgeon meant by "too much work" is that an onco who has a pump patient has to really watch the liver function of the patient and has to be really good at it. Other oncos may not want to put in the extra work or have the experience to have it be successful.

For right now I am obviously glad we went this route. I will be starting in 4 weeks on a 6-7 month regimen of FOLFURI as systemic and FUDR directly in the pump.

lmliess · February 2009

mom_2_3 said:
Pump
Carol,

I can't comment too much on the HAI pump as I just had one installed on Friday (2-20). I am a patient at MSK. When we went initially to an oncologist at our local hospital (Morristown, NJ) we were told I would not be resectable (by the oncologist). We immediately headed over to MSK. Almost 3 months to the day after being told I was not resectable I had my liver resection and colon resection and implantation of the pump. I am currently recovering in the hospital.

What the MSK liver surgeon told us is that there is a 50% chance of recurrence in liver but with the pump the chance of recurrence would be 30%. I would take those odds any day. My husband asked why so many other oncologists were hesitant with the pump. In fact, our original oncologist called the pre-eminent oncologist as MSK the "pump lady" and he told us a study showed only 4 monmths added lifespan. Well, MSK does HAI chemo and systemic at the same time and that was not part of that study. Additionally, we are looking at the HAI pump as adjvuvant therapy as they were able to remove the entire left lobe of my liver and a wedge resection of my right (single tumor). In researching the pump I came across a number of people who were long-term NED survivors and many of them had had a liver pump.

Our liver surgeon said that any dr diagnosed with Stage IV to liver at MSK would have the pump. His comment about other oncologists that don't like it is that it is too much work. He felt many oncologists like to prescribe chemo and be done with it. Our first onco prescribed 6 months of FOLFOX and Avastin with a scan at 6 months. Our onco at MSK said FOLFOX only (didn't want Avastin to compromise healing) for 2 months and then a scan to determine which direction my mets were going. My mets luckily shrunk by about 50% by the 4th treatment. And our onco immediately referred me to surgery. What the liver surgeon meant by "too much work" is that an onco who has a pump patient has to really watch the liver function of the patient and has to be really good at it. Other oncos may not want to put in the extra work or have the experience to have it be successful.

For right now I am obviously glad we went this route. I will be starting in 4 weeks on a 6-7 month regimen of FOLFURI as systemic and FUDR directly in the pump.

Liver surgery?
How did your liver resection go Friday mom_2_3? I just got my Pet Scan results back and found out I will need to have a colostomy bag and liver resection. I am scared! How long was your surgery and how are you feeling?

mom_2_3 · February 2009

lmliess said:
Liver surgery?
How did your liver resection go Friday mom_2_3? I just got my Pet Scan results back and found out I will need to have a colostomy bag and liver resection. I am scared! How long was your surgery and how are you feeling?

Imiless
I was feeling very nervous prior to my re-section but all I could think of was that I would hopefully be NED after the surgery. It was very important mental step for me. So my feelings of excitement outweighed my nervousness.

My surgery was scheduled for 7:00 am so we had to be at the hospital at 5:45. They had me change and meet the anesthiologist and had a line connected to my power port. They took me in at about 7:10 and I was asleep by 7:15 or so. I asked the anesthesiologist whether the anesthesia was working and the next thing I know I was waking up in recovery. The surgery took approximately 7.5 hours. The first step in the sugery was done by by liver surgeon and his fellow. They removed the entire left lobe and a wedge resection of a single tumor on the right-hand side. I had a very good response to chemo (4 treatments) and they had all shrunk significantly. The surgeon also removed my gall bladder as it is necessary for it to be removed if they do the hepatic pump. Finally, they did a manual feel of the liver and an ultrsound to make sure there were no other tumors. Luckily I was clean.

After all that was done my colon surgeon came in and did a lower anterior resection. I had pre-consented to an ileostomy (temp) and to have my ovaries and tubes removed. The colon surgeon said that the tissue looked so good the ileostomy wasn't necessary. And because the ovaries looked fine he left them in. He also looked for any peritoneal seeding but didn't see any.

Once I came out of surgery and woke up I saw my husband for a little while and both surgeons came in to talk with me but I was pretty much out of it. My husband left for the night and returned Saturday morning after I was moved to a regular floor (as opposed to the post-surgery floor).

I felt pretty well on Saturday and took a couple of walks. When I woke up I had a catheter attached as well as a pain pump and an IV bag. My pain pump has dilaudid (sp?) in it. Today, however, it has hit me a bit harder. The surgeon told me that because all the anesthesia is worn off that Day 2 is tougher than Day 1 post-surgery. I had a slight cold coming into the surgery and any slight coughs are painful. It is hard to breathe in fully as I have about 30-40 staples in a straight line down my abdomen. The staples start right at the breastbone and go down to my c-section scar making a turn around the belly button.

It is still hard to move about but I did have the catheter removed as I can't stand the feeling of having one in. The pain is only really tough when I move so I am trying not to move as much as possible but I stll need to get up and use the restroom periodically. The dr said not to expect any BMs until 4-5 days after surgery. He recommended I stay on a liquid/soft diet as long as possible.

All in all the pain is greater than my c-sections but I feel lucky I was able to have the surgery. The drs told me that at MSK they have a 60% disease-free survival at 5 years. We are praying to be in that percentage but will need to take it scan by scan like everybody else. Tomorrow morning they will inject a dye into my hepatic port and do a scan to make sure it is working properly.

Today when my husband visited me he brought me a charm bracelet. When I was first diagnosed with cancer we made our motto "just keep swimming" from Finding Nemo movie. So he found a jeweler who made a charm of the fish and had that inscribed on the back. It is a great present and will always remind me to keep moving forward. Finally, my brother-in-law (who is like a brother to me) wento to church today (he NEVER goes) to pray for me. He considered a number of churches and ended up at a Reformed church. At the service the minister asked for prayers for any family members facing sickness or disease so he took comfort in that. After the service a woman went up to him and said he looked new and what was the purpose of his visiting. He told her and then found out her name was Amy (like me) so he took that as a good sign. We take all the signs we can get...

Hopefully this was helpful. PM me if you want any other details.

Best wishes to you on your own surgery. Where will it be performed?

ADKer · February 2009

HAI pump
My HAI pump was installed at the same time as my colon resection. At that point, the metastatic tumors to my liver were not resectable. As already indicated, the research showing that HAI does not increase survival did not involve systemic chemo administered together with chemo through the HAI pump. My cancer was quite advanced at diagnosis and I believe that the pump was critical in allowing me to have liver resection. At my first CT scan after liver resection, tiny nodules (less than 1mm) were found in my lungs, not surprising to me due to the severity of my disease at diagnosis. Xeloda has stablilized them, nothing else has appeared for a few months and I will continue to seek to have those treated successfully also. So, the HAI pump is not the answer to everything but can be very helpful. It does require expertise and experience in both the oncologist monitoring the patient and the surgeon who installs it, which in my opinion probably prevents it from being offered to all patients who would likely benefit. If I were in your husband's position, I would seek a second opinion as to whether or not the HAI pump would be helpful at this point. Sloan is not the only institution with expertise and extensive experience with the HAI pump but I cannot give you a list of other places that you might go if Sloan is not convenient.

PhillieG · February 2009

The Pump
I had the hepatic artery pump installed in Sept 04 and have had no problems with it at all. As you know it gives chemo right to the 'trouble spots'. I have had no recurrence of cancer in my liver at all (which was 65% removed). I've had mets in my lungs ever since then but that's another story. I'm glad I went with the pump, I think it saved my life.
BTW: I had it done at SK and my Onc is a Ms. I think She/they were in the forefront of using hepatic pumps for treatment.
At any rate, here I am 5 years later...Still not NED but I'm here

sladich · February 2009

HAI Pump
Carol,

I was diagnosed in September 2004 with Stage 4 colon cancer. After having a colon resection, lung surgery, and Folfox, my cancer came back in my liver. I underwent a liver resection along with having the HAI pump installed. Unfortunately, the fluik around the pump became infected so I had it removed 4 months later. I loved it. It beats systemic chemo. A year later, I had more tumors in my liver and underwent a chemoembolization, RFA, and chemoembolization. It can't hurt to give it a try. A year after this they found a tumor in my lung again and I had a lung RFA in December 2008. Recent scans showed all clear. I've made it to the one-year anniversary of no evidence of cancer. Tell your hubby to hang in there. Best of luck.

Debbie

fez1 · February 2009

mom_2_3 said:
Pump
Carol,

I can't comment too much on the HAI pump as I just had one installed on Friday (2-20). I am a patient at MSK. When we went initially to an oncologist at our local hospital (Morristown, NJ) we were told I would not be resectable (by the oncologist). We immediately headed over to MSK. Almost 3 months to the day after being told I was not resectable I had my liver resection and colon resection and implantation of the pump. I am currently recovering in the hospital.

What the MSK liver surgeon told us is that there is a 50% chance of recurrence in liver but with the pump the chance of recurrence would be 30%. I would take those odds any day. My husband asked why so many other oncologists were hesitant with the pump. In fact, our original oncologist called the pre-eminent oncologist as MSK the "pump lady" and he told us a study showed only 4 monmths added lifespan. Well, MSK does HAI chemo and systemic at the same time and that was not part of that study. Additionally, we are looking at the HAI pump as adjvuvant therapy as they were able to remove the entire left lobe of my liver and a wedge resection of my right (single tumor). In researching the pump I came across a number of people who were long-term NED survivors and many of them had had a liver pump.

Our liver surgeon said that any dr diagnosed with Stage IV to liver at MSK would have the pump. His comment about other oncologists that don't like it is that it is too much work. He felt many oncologists like to prescribe chemo and be done with it. Our first onco prescribed 6 months of FOLFOX and Avastin with a scan at 6 months. Our onco at MSK said FOLFOX only (didn't want Avastin to compromise healing) for 2 months and then a scan to determine which direction my mets were going. My mets luckily shrunk by about 50% by the 4th treatment. And our onco immediately referred me to surgery. What the liver surgeon meant by "too much work" is that an onco who has a pump patient has to really watch the liver function of the patient and has to be really good at it. Other oncos may not want to put in the extra work or have the experience to have it be successful.

For right now I am obviously glad we went this route. I will be starting in 4 weeks on a 6-7 month regimen of FOLFURI as systemic and FUDR directly in the pump.

things sound good
Thanks for your input. Your plan sounds very promising. Best of luck!

Carol

fez1 · February 2009

ADKer said:
HAI pump
My HAI pump was installed at the same time as my colon resection. At that point, the metastatic tumors to my liver were not resectable. As already indicated, the research showing that HAI does not increase survival did not involve systemic chemo administered together with chemo through the HAI pump. My cancer was quite advanced at diagnosis and I believe that the pump was critical in allowing me to have liver resection. At my first CT scan after liver resection, tiny nodules (less than 1mm) were found in my lungs, not surprising to me due to the severity of my disease at diagnosis. Xeloda has stablilized them, nothing else has appeared for a few months and I will continue to seek to have those treated successfully also. So, the HAI pump is not the answer to everything but can be very helpful. It does require expertise and experience in both the oncologist monitoring the patient and the surgeon who installs it, which in my opinion probably prevents it from being offered to all patients who would likely benefit. If I were in your husband's position, I would seek a second opinion as to whether or not the HAI pump would be helpful at this point. Sloan is not the only institution with expertise and extensive experience with the HAI pump but I cannot give you a list of other places that you might go if Sloan is not convenient.

difficult to find others who recommend
Hi there,

Sloan-Kettering is convenient but we have been to The University of Pennsylvania, Fox Chase Cancer Center and Johns Hopkins- none of which recommended the HAI pump. I'm still interested, however. Can you e-mail me off list at cppo1212@aol.com and tell me what surgeon did it at Sloan? Thanks so much.

Carol

fez1 · February 2009

sladich said:
HAI Pump
Carol,

I was diagnosed in September 2004 with Stage 4 colon cancer. After having a colon resection, lung surgery, and Folfox, my cancer came back in my liver. I underwent a liver resection along with having the HAI pump installed. Unfortunately, the fluik around the pump became infected so I had it removed 4 months later. I loved it. It beats systemic chemo. A year later, I had more tumors in my liver and underwent a chemoembolization, RFA, and chemoembolization. It can't hurt to give it a try. A year after this they found a tumor in my lung again and I had a lung RFA in December 2008. Recent scans showed all clear. I've made it to the one-year anniversary of no evidence of cancer. Tell your hubby to hang in there. Best of luck.

Debbie

where were you treated
Wow Debbie, you've really been through it. Congrats on your one year anniversary. My husband never made it more than 9 months. It's hard to get a clear picture. He's between the pump and Sirt (SirSpheres) right now. What to try next? I don't know. All I know is that both he and I are weary of cancer. But. as everyone else on this list, we just press on. Thanks so much for your post. Talking it out with you guys gives us the best information- from the experts! We'll think everything over.

Carol

fez1 · February 2009

PhillieG said:
The Pump
I had the hepatic artery pump installed in Sept 04 and have had no problems with it at all. As you know it gives chemo right to the 'trouble spots'. I have had no recurrence of cancer in my liver at all (which was 65% removed). I've had mets in my lungs ever since then but that's another story. I'm glad I went with the pump, I think it saved my life.
BTW: I had it done at SK and my Onc is a Ms. I think She/they were in the forefront of using hepatic pumps for treatment.
At any rate, here I am 5 years later...Still not NED but I'm here

Awesome!
Well that's the story that made my night. Could you share with us who your surgeon was. The one that we saw at Sloan-Kettering I did not "gel" with, although when I tell doctors that we had a consult with him they always say impressive things about him. I know that there is more than one who inserts the pump. My husband's issue is that no chemo regimen has ever really worked for more than a short time so why would this?? It's a decision that only he can make. My email is cppo1212@aol.com. I'd appreciate it. Take care.

Carol

HAI Pump

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