HAI Pump Questions

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sfmarie
sfmarie Member Posts: 602
edited March 2014 in Colorectal Cancer #1
Hi-

Anyone with experience with HAI Pump? Sister dx 3/09 stage IV with mets to liver and peritoneum. Supposed to undergo liver resection 8/26 but found another tumor. Waiting another scan. May do HAI pump. Can you comment on the treatment plan and how often they administer the chemo?

Thanks!
Marie

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  • mom_2_3
    mom_2_3 Member Posts: 953 Member
    #2
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    Information
    Marie,

    Sorry to hear that your sister had another met discovered. Hopefully HAI therapy can be of assistance to her. I posted a while back about my own experience with the HAI pump and the treatment protocol. Here is the link (http://csn.cancer.org/node/172274). If you have any more questions about it, post here or send me a PM. I know there are a number of individuals on the board that have had or still have the pump who can be of assistance. It is a great technology.

    All the best to your family,
    Amy
  • sfmarie
    sfmarie Member Posts: 602
    #3
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    mom_2_3 said:

    Information
    Marie,

    Sorry to hear that your sister had another met discovered. Hopefully HAI therapy can be of assistance to her. I posted a while back about my own experience with the HAI pump and the treatment protocol. Here is the link (http://csn.cancer.org/node/172274). If you have any more questions about it, post here or send me a PM. I know there are a number of individuals on the board that have had or still have the pump who can be of assistance. It is a great technology.

    All the best to your family,
    Amy

    More Questions
    Thanks Amy.

    I read your post and still have a few more questions.

    What was the usual schedule like? When Day 1 you had the HAI chemo and Day 15 systemic chemo, were there any tests scheduled in between?

    I am wondering this because the HAI facility is 5 hours from her home. He onc where she lives does not do this type of treatment and we are wondering if it is possible to commute or does she need to temporarily relocate herself and family.

    Marie
  • mom_2_3
    mom_2_3 Member Posts: 953 Member
    #4
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    sfmarie said:

    More Questions
    Thanks Amy.

    I read your post and still have a few more questions.

    What was the usual schedule like? When Day 1 you had the HAI chemo and Day 15 systemic chemo, were there any tests scheduled in between?

    I am wondering this because the HAI facility is 5 hours from her home. He onc where she lives does not do this type of treatment and we are wondering if it is possible to commute or does she need to temporarily relocate herself and family.

    Marie

    Questions
    Marie,

    On the days that I have systemic chemo I also have my HAI port accessed. They inject into the pump saline as it needs something in it at all times. So every time I go to my oncologist for treatment they are accessing the HAI port as well as my systemic port (except for the liver pump days in which I have no access to my systemic - powerport at all). I hope this makes sense.

    To summarize:

    Day 1: HAI chemo (inject FUDR into my HAI pump which is accessible via a port in my abdomen)

    Day 15: Systemic chemo via my powerport (chest) and they empty the HAI pump and inject saline into it.

    Day 29: Systemic chemo via my powerport (chest) and they empty the HAI pump and inject saline into it.

    Day 36: HAI chemo - repeat of Day 1 activities

    Day 50: Systemic chemo - repeat of Day 15 activities

    Day 64: Systemic chemo - repeat of Day 29 activities


    Between those treatments I don't typically have other appointments. Every 4 systemic treatments I do have a CT scan and get the resulst on my liver pump day. I see my oncologist every 5 weeks.

    My oncologist does have patients that are not local to her and typically what she will do is see the patient every 5 weeks for the liver chemo infusion. The saline injections into the pump are done at a local oncologist's office. I know for one particular person whose local office didn't have any training in HAI that my DR sent a technician there (to Texas from NYC) to train the local staff on the saline infusions. So the patient would only need to travel once every 5 weeks. I am not sure if that is an option for your sister but perhaps you could consult with the HAI oncologist to see if there are any experienced in saline injections more local to you (even if an hour or two away). If it was me and I didn't have the option to go to anyone local for saline injections I would travel the 5 hours. Based on everything I have read (studies as well as anecdotal) I believe that the HAI pump can be of benefit to my overall survival. I am praying it does the job and keeps my liver clear of any future liver mets.

    Where was your sister's additional met? I am only asking as I know in some places they will only do the HAI therapy of the mets are confined to the liver only. That is not an absolute but something to think about.

    Finally, I am not sure where your sister is considering HAI treatment...with Dr Lenz? Implanting an HAI can be tricky. The more the surgeon does, the better. At Memorial Sloan-Kettering they do between 200-300 a year. The more the surgeon does the less likely to experience complications. Additionally, at Sloan they do perfusion studes to ensure that the pump is implanted correctly and perfusing the liver correctly. Ask your surgeon if this will be done. I wonder if your sister can't have the pump implanted at Sloan and then managed in CA. Just a thought.

    Post any other questions.

    All the best,
    Amy
  • sfmarie
    sfmarie Member Posts: 602
    #5
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    mom_2_3 said:

    Questions
    Marie,

    On the days that I have systemic chemo I also have my HAI port accessed. They inject into the pump saline as it needs something in it at all times. So every time I go to my oncologist for treatment they are accessing the HAI port as well as my systemic port (except for the liver pump days in which I have no access to my systemic - powerport at all). I hope this makes sense.

    To summarize:

    Day 1: HAI chemo (inject FUDR into my HAI pump which is accessible via a port in my abdomen)

    Day 15: Systemic chemo via my powerport (chest) and they empty the HAI pump and inject saline into it.

    Day 29: Systemic chemo via my powerport (chest) and they empty the HAI pump and inject saline into it.

    Day 36: HAI chemo - repeat of Day 1 activities

    Day 50: Systemic chemo - repeat of Day 15 activities

    Day 64: Systemic chemo - repeat of Day 29 activities


    Between those treatments I don't typically have other appointments. Every 4 systemic treatments I do have a CT scan and get the resulst on my liver pump day. I see my oncologist every 5 weeks.

    My oncologist does have patients that are not local to her and typically what she will do is see the patient every 5 weeks for the liver chemo infusion. The saline injections into the pump are done at a local oncologist's office. I know for one particular person whose local office didn't have any training in HAI that my DR sent a technician there (to Texas from NYC) to train the local staff on the saline infusions. So the patient would only need to travel once every 5 weeks. I am not sure if that is an option for your sister but perhaps you could consult with the HAI oncologist to see if there are any experienced in saline injections more local to you (even if an hour or two away). If it was me and I didn't have the option to go to anyone local for saline injections I would travel the 5 hours. Based on everything I have read (studies as well as anecdotal) I believe that the HAI pump can be of benefit to my overall survival. I am praying it does the job and keeps my liver clear of any future liver mets.

    Where was your sister's additional met? I am only asking as I know in some places they will only do the HAI therapy of the mets are confined to the liver only. That is not an absolute but something to think about.

    Finally, I am not sure where your sister is considering HAI treatment...with Dr Lenz? Implanting an HAI can be tricky. The more the surgeon does, the better. At Memorial Sloan-Kettering they do between 200-300 a year. The more the surgeon does the less likely to experience complications. Additionally, at Sloan they do perfusion studes to ensure that the pump is implanted correctly and perfusing the liver correctly. Ask your surgeon if this will be done. I wonder if your sister can't have the pump implanted at Sloan and then managed in CA. Just a thought.

    Post any other questions.

    All the best,
    Amy

    Thanks Amy
    For the quick response. Reading this is great and gives me hope that she can receive this treatment if they offer it to her and still live and continue her routine with her family (like you she has small children; 4, 6 & 8).

    She lives in Santa Barbara and is also seeing onc. at Stanford and liver surgeon at Stanford. The surgeon only does liver surgery and I am confident that they have extensive experience with the HAI pump.

    She was scheduled to have liver resection this Wed., but after looking at one of her scans, they saw another possible tumor near the pancreas, that her onc. in SB missed or dismissed. So, she is having another scan right now, but they discussed the spheres and pump as an alternative if they cannot resect. This has been one long and emotional journey and I have tried to encourage her to join this board. She has already completed 12 rounds of the chemo via her port (not sure the exact drugs) and while it did work great in the beginning her levels were hitting a plateau. She has mets to the liver and peritoneum. They think the chemo has shrunk most of the mets to the liver and peritoneum.

    So, here we are. Not really sure what the next steps are until we get more info. from the scan and oncs.

    Again, thanks for the information and kindness. I will keep you and your family in my prayers as well.

    Marie
  • PhillieG
    PhillieG Member Posts: 4,866 Member
    #6
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    HAI pump
    I also had the pump installed almost 5 years ago. It worked great. I've had no liver problems at all since. At first it was a bit uncomfortable and if my wife accidentally bumped it if we were sitting on the couch together, I'd jump. Now it's not nearly as tender by any means. I don't even notice it's there. I have not been using it actively since about 6 months after my operation and they inserted it. I have to keep it primed and have it refilled with an inert liquid every 8 weeks or so. Once they remove it, it can not be reinserted so since it's not doing any damage I will keep it in.

    Mom_2_3 really gave the best info on it. I do not recall what was in it and the schedule I was on with it. She's the best source around!
    It did work great though and I would recommend it.
    -phil
  • SSmith25
    SSmith25 Member Posts: 11
    #7
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    me too
    Pump implanted 2005 at Sloan Kettering. The results are very encouraging. When I got mine, some docs were skeptical, but that seems to be changing.
  • sfmarie
    sfmarie Member Posts: 602
    #8
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    SSmith25 said:

    me too
    Pump implanted 2005 at Sloan Kettering. The results are very encouraging. When I got mine, some docs were skeptical, but that seems to be changing.

    Thanks Amy and Phil
    For the information. We hope we can get to that stage. Right now, they are talking more chemo before they discuss any other options.
  • sfmarie
    sfmarie Member Posts: 602
    #9
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    SSmith25 said:

    me too
    Pump implanted 2005 at Sloan Kettering. The results are very encouraging. When I got mine, some docs were skeptical, but that seems to be changing.

    Question for SSmith25
    I read your profile and wondered was the pump inserted in your abdomen for the mets to the liver or mets to something else? My sister was getting ready to have liver resection when a recent scan showed new cancer in a lymph node and colon, even after she had part of her colon removed. She already completed 4 months of chemo; Erbitux and 5FU. Now, docs. are saying more chemo before they can talk about any other procedures. Any advice/thoughts/experiences greatly appreciated.
  • mom_2_3
    mom_2_3 Member Posts: 953 Member
    #10
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    sfmarie said:

    Question for SSmith25
    I read your profile and wondered was the pump inserted in your abdomen for the mets to the liver or mets to something else? My sister was getting ready to have liver resection when a recent scan showed new cancer in a lymph node and colon, even after she had part of her colon removed. She already completed 4 months of chemo; Erbitux and 5FU. Now, docs. are saying more chemo before they can talk about any other procedures. Any advice/thoughts/experiences greatly appreciated.

    Liver only
    Marie,

    I am sure SSmith25 will reply concerning your question but I thought I would tell you that as far as I am aware the HAI pump is used only liver mets. As the pump is routed directly into the hepatic artery it would only dispense chemo to the liver (an no other mets). Lymph nodes are treated with systemic chemo and omentum mets are treated with systemic (which I have heard doesn't work overly well with them) and with HIPEC/IPEC (heated or non-heated chemo applied directly into the abdominal cavity).

    All the best,
    Amy
  • PhillieG
    PhillieG Member Posts: 4,866 Member
    #11
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    mom_2_3 said:

    Liver only
    Marie,

    I am sure SSmith25 will reply concerning your question but I thought I would tell you that as far as I am aware the HAI pump is used only liver mets. As the pump is routed directly into the hepatic artery it would only dispense chemo to the liver (an no other mets). Lymph nodes are treated with systemic chemo and omentum mets are treated with systemic (which I have heard doesn't work overly well with them) and with HIPEC/IPEC (heated or non-heated chemo applied directly into the abdominal cavity).

    All the best,
    Amy

    True
    Hi Amy, I did some Googling around and Dr. K's sister, Margaret also did a lot of research and development with the HAI pump. I believe her field of expertise is breast cancer so I looked to see if it was used in places other than the liver but but I could not find any. It makes sense because of it's name. It is a great idea that I would not be surprised if it became used in other area but to my knowledge it isn't at this time
    -p
  • sfmarie
    sfmarie Member Posts: 602
    #12
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    PhillieG said:

    True
    Hi Amy, I did some Googling around and Dr. K's sister, Margaret also did a lot of research and development with the HAI pump. I believe her field of expertise is breast cancer so I looked to see if it was used in places other than the liver but but I could not find any. It makes sense because of it's name. It is a great idea that I would not be surprised if it became used in other area but to my knowledge it isn't at this time
    -p

    Thanks Amy and Phil
    I read that the HIPEC is not done if there are liver mets and the pump is not done if there are mets elsewhere.
  • mom_2_3
    mom_2_3 Member Posts: 953 Member
    #13
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    sfmarie said:

    Thanks Amy and Phil
    I read that the HIPEC is not done if there are liver mets and the pump is not done if there are mets elsewhere.

    Not sure
    Marie,

    Not sure about the requirements for HIPEC as I have not investigated it. As for HAI, I know people at clinic that had lung mets and still had the HAI pump implanted. My suggestion would be to get an opinion and then another and then another until you find one who will treat your sister as aggressively as she would like.
  • sfmarie
    sfmarie Member Posts: 602
    #14
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    mom_2_3 said:

    Not sure
    Marie,

    Not sure about the requirements for HIPEC as I have not investigated it. As for HAI, I know people at clinic that had lung mets and still had the HAI pump implanted. My suggestion would be to get an opinion and then another and then another until you find one who will treat your sister as aggressively as she would like.

    Persistent
    Amy-
    Yes, we will keep looking. That is great advice. Thank you.
    Marie
  • SSmith25
    SSmith25 Member Posts: 11
    #15
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    sfmarie said:

    Question for SSmith25
    I read your profile and wondered was the pump inserted in your abdomen for the mets to the liver or mets to something else? My sister was getting ready to have liver resection when a recent scan showed new cancer in a lymph node and colon, even after she had part of her colon removed. She already completed 4 months of chemo; Erbitux and 5FU. Now, docs. are saying more chemo before they can talk about any other procedures. Any advice/thoughts/experiences greatly appreciated.

    Infusion from the pump goes
    Infusion from the pump goes directly into the liver. I was part of the initial clinic trial, and so the guidelines to qualify were very specific. Now that the treatment is more widespread, I don't know what the criterion are.
  • Unknown
    Unknown
    #16
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