Postby gfpiv » Tue Mar 28, 2017 8:49 pm
Congrats Mike, glad things look promising for you with MSK/Kemeny/HAI. Just a few quick responses:
1 - once you start HAI chemo (maybe about a month after install), you'll get FUDR (essentially 5-FU) in the pump for a 2-week slow-drip. Likely you will do systemic (in your case, maybe FOLFIRI, with or without Avastin?) that same day to address non-liver cells...and maybe even start 2 weeks earlier. After 14 days of FUDR in pump, you'll get it drained and they'll put saline/glycerol just to keep the pump primed; at that time you will likely also get your systemic chemo too. Then 2 weeks after that, drain glycerol and refill with FUDR, another 2 weeks on that (and systemic).
2 - I had essentially ZERO noticeable side effects from HAI...I honestly couldn't have told you the difference between FUDR and glycerol/placebo. My understanding is that this is common.
3 - Of course, HAI delivers like 6 times the concentration of 5-FU/FUDR directly to your liver that systemic would, so it can...and almost certainly will, over a long enough time period...cause some sort of temporary or permanent damage to liver and/or bile ducts, etc. Luckily they are VERY cognizant of this, and do a great job monitoring you (and esp. liver labs), so they can reduce or stop HAI when your body/liver can't take it any more. After about a year and a half on HAI, my liver labs became too escalated, and coupled with what they determined was bile duct damage/blockage, they eventually had to reduce and then stop HAI. In many cases liver labs return to normal after stopping...though almost all my liver labs have stayed greatly elevated to this day. Luckily however, my bilirubin is back to basically normal, so there is no jaundice/itching that was frustrating for a short time. Again, in my specific case I had bile duct damage which was heading me towards liver failure - until a great MSK radiology doc (not my local one) found it, put in a stent or 2...and then eventually my amazing hepatic surgeon at MSK did a permanent bile duct / small intestine bypass that has made my life great ever since. I was concerned that stopping chemo due to liver damage would result in a recurrence...but turns out almost all the nasty stuff had been killed/calcified by then (except for one pesky liver met that we burned out a couple years later).
4 - My local onc was able to be trained (relatively easy) to drain the last drops of FUDR from the pump, and refill with saline/glycerol. So that saved me one of my 8-hour round-trips to MSK each month. You'll likely need to go to MSK to get the pump refilled with the good stuff though.
Best of luck with your surgery and recovery!
Chip
Chip
DX stage IV CC Jan '10, numerous unresectable liver mets
FOLFOX + Avastin Feb-Jul '10
Colon resection, HAI install Aug '10
Systemic FOLFIRI and hepatic FUDR Dec'10-May'12
Chemo break May'12-pres (tumors calcified & stable, knock on wood)
Billiary bypass surgery and SBRT on pesky liver met in 2015