You are right that if you have a lung met you would not be a candidate for the HAI pump. Definitely wise to put off chemo until they determine what the lung nodule is and if it needs to be removed. When I was seeking opinions about my liver met, I saw a couple different surgeons. One recommended chemo before resection. But the other said that could damage my liver to the point where it’s difficult to resect. So in agreement with my oncologist I chose surgery first. I went the HAI pump route because I wanted to reduce my chances of anything coming back in my liver, and because I live close to MSK, am young, etc. I do worry sometimes that if it ever comes back after all this I’ll have run out of systemic chemo options (not sure if that’s true), but then I’ll also know that I did everything I could upfront. The pump has been fine - I still have a little soreness from surgery but the access and use of it is easy and there are no side effects from the chemo, which I started on Wednesday. I’ll be starting systemic FOLFIRI in a couple weeks. The main inconvenience of the pump is that I have to get it filled every two weeks, even after chemo is over, because I have the new Medtronic pump. This is because Dr Kemeny kept all the old Codman pumps for her clinical trial and as a KRAS mutant I didn’t qualify for it. So I have to think about getting it refilled every two weeks, and I want to keep my pump for a few years, and I don’t know of many other places besides MSK that have pump programs. This basically means I have to make travel plans accordingly, a small price to pay for still being alive in a few years.
Anyway, probably more than you wanted to know. And there may be great reasons for you not to do follow-up chemo. I was just curious!
36 year-old female
May 2017: Dx rectal cancer at T3N2M0
MSS, KRAS G12A
June-July 2017: 28 days of XEL/radiation
Sep 2017: laparoscopic LAR/loop ileostomy
Oct 2017 - February 2018: XELOX six rounds
Mar 2018: reversal
Apr 2018: CEA 2.1, normal blood counts
May 2018: CT liver spot
Aug 2018: Abnormal PET, CEA 2.4
Sep 2018: robotic and laparoscopic liver resection with HAI pump
Oct 2018: Clear CT and colonoscopy, CEA 1.7, begin six months FUDR and FOLFIRI