Number of Hai treatments

[hart2hart]

So Pete has had 4 Pump treatments so far, would be five but Dr. K skipped a month due to
high liver enzymes.

It is usually six treatments? She hasn't said a word about it to Pete.....
Is it her way? Just wanted to know others experience with this. Does
she just tell you last minute? I'm just wondering........

Folfiri is kicking Pete's butt this week --- EXTREME FATIQUE - Worst it's been.
He'll probably feel better beginning of the week!! Hope so!


Go UCONN!



Julie H
Stamford, CT

[mom_2_3]

Julie,

My enzymes got high the longer I went through treatment. I had 6 HAI treatments in total. This was the number she told me and the number I completed. I believe we held up my fast 5FU treatment. I had treatments from March 2009 through the beginning of November 2009. It took a bit longer as I had an allergic reaction (cardiac arrest) from the Oxali and had a hospitalization and held up treatment for a bit from that.

HTH,
Amy

[juliej]

Six is the norm for adjuvant treatment. She sometimes cuts it down if liver enzymes stay elevated. That means Pete is close to the end! You should ask at the next appointment just so you know for sure (plus, as a patient, I can tell you that the countdown is wonderful!).

[Marian1961]

Please excuse my ignorance but I'm a little confused. While a patient is receiving HAI infusions they are also continuing with their "regular" chemo? I thought the point of HAI was target chemo to the liver when other therapies were not effective, or not effective enough. Thanks for any info.

[Badass]

I had six, and yes, the HAI treatments are given in conjunction with systemic. The HAI targets the liver specifically, and at much higher doses than one could tolerate systemically. My understanding is that 1. there is synergy with the combo of systemic and hai (systemic includes additional drugs like oxaliplatin or irinotican) and 2. the systemic could target circulating cancer cells

Jane

[Marian1961]

Thank you for the reply and information. My brother is currently gathering his info to send to Dr. K for an opinion about HAI. FOLFOX was a failure, 5FU/Avastin has been minimally effective. I will be interested to see what systemic chemo potion is recommended if he is a candidate for HAI since, so far, none of it is working. The whole journey is hard but this feels like a fork in the road and which way to go is scary and difficult.

[mymom]

Hi. It is six treatments. I have to ask mom how many she had. I do not remember if she had all six.

[gfpiv]

For those who are NED / liver-resected at HAI implantation, it may well be that 6 treatments is standard; I don't know, but it sounds reasonable. For others of us that are/were non-resectable, HAI treatments can be open-ended as far as I know...but are often/usually limited/reduced over time due to a buildup of liver toxicity. I've never been resectable, so I was on HAI with almost no break (along with systemic FOLFIRI) for about a year and a half. Eventually the toxicity got to me, so we had to stop (and have been lucky enough not to have to go back to chemo yet).

Yes, whenever possible they try to do systemic also, since HAI doesn't address and extra-hepatic disease. Results are usually best when HAI is done as first-line treatment, but mine worked well as second-line (post-FOLFOX), and I imagine it can even be done as third-line.

And Marian, to be honest in your husband's case I wouldn't have expected 5-FU and Avastin to work very well after FOLFOX didn't. 5-FU is contained within the FOLFOX cocktail (5-FU plus Oxaliplatin), and although Avastin can be somewhat effective in conjunction with other meds, its effects are rarely dramatic. In the absence of a reason not to, your husband will likely be put on systemic FOLFIRI (5-FU plus Irinotecan) next, regardless of whether or not he is a good candidate for HAI.

Best of luck to those in the trenches.
-Chip

[Marian1961]

Thanks for all the info.

Chip, how was it determined that your liver mets had calcified? Is this an unusual response or something that happens in some patients vs shrinking?

I can not, frankly, grasp how there has been so much poison pumped into one human being the last 6 months-----knocking out lung met, knocking back primary colon tumor and yet the liver either progresses or stands still.

Also, I wasn't clear. He has done rounds of Folfiri. I'm going to have to go look at my notes/records to remember why it was changed but it was a blood value that just went out of bounds. There have been so many things go opposite of intention, I can't remember them all today. I just know none of this shit has worked.

[gfpiv]

Yes Marian, it is amazing the amount of chemo that many folks here have endured. And, although there are a few things that may help a little bit to improve chemo effectiveness and reduce side effects (education, exercise, eating well), it's largely a crapshoot, unfortunately. There are a few other meds that can be tried with HAI - e.g cetuximab, mitomycin, but for the most part it's usually systemic FOLFOX or FOLFIRI as first option if possible.

As for 'calcification' of my tumors, it seemed a remarkable phenomenon to me. I've heard of calcification before, but most of the time I suspect that the lesions that are killed just 'go away' and are expelled by the body. That happened with many of my smaller lesions, but the larger ones pretty much stayed there in calcified form, hopefully dead/dormant. On my scans they appear as white spots (in contrast to the medium grey of healthy liver and dark grey of liver tumors). Odds are that someday the cancer will come back, but I'll enjoy what time I'm given until then.

Best wishes to your brother. (And all others challenged by this heinous disease.)
-Chip

[SideKick]

Hi there,
I have a question about the 20% systemic chemo and using the Hai pump. Which method do they use to adminster the 20% systemic chemo and how long does it take...I.E. hours? days?

Thank you,

S.K.

[gfpiv]

Hi SK,

Not sure what you mean by "20%" systemic, but while I had my HAI, my systemic chemo was exactly the same as if I wasn't on HAI at all. For me (and many), systemic was either FOLFIRI or FOLFOX, with an infusion of either Irinotecan or Oxaliplatin respectively at the cancer center, along with the 48-hour take-home pump with 5-FU - done every 2 weeks. They prefer not to do Avastin while on HAI, because it can slightly increase the likelihood of bile duct problems.