Hospitals that install HAI pump?

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cartech78
Posts: 54
Joined: Thu Oct 25, 2018 6:22 pm

Re: Hospitals that install HAI pump?

Postby cartech78 » Sun Dec 30, 2018 2:17 pm

mpbser wrote:P.S. It's good to know how far out these procedures are being booked there. We are expected to meet with Dr. Kingham before making the decision. I'm surprised at how quickly you got yours scheduled.

Thats funny! I just read your message. You wont be one of the first to get the new pump, they have done a bunch of them already. The service of the new pump is where the conundrum is. It requires maintenance every two weeks which sucks but i guess that is what it is. Hopefully they can find you a hospital close to where you live to service you on the off weeks. There are a few Facebook groups im in with members that have the new pump already if you want to ask questions to people that have them. Check out Liver Mets from CRC on Facebook. I cant remember if Hieders has the Codman or the Medtronic.
40 Y/o male
Dx 10/5/18 stage lV CRC
Sg colon T3N1bM1a
Histologic grade-G2
7 inoperable liver mets largest 4.5 cm
Colon resection 10/6/18 clean margins
Starting FolFox on 11/12/18 3rnds
Report back to MSK on 12/18/18 for further instructions.

chadwick1
Posts: 23
Joined: Sat Oct 13, 2018 9:04 am

Re: Hospitals that install HAI pump?

Postby chadwick1 » Sun Dec 30, 2018 8:24 pm

I saw the name mentioned and just wanted to say I had a liver resection with Dr. Kingham last month and it went really well. Both he and my onc agreed I wasn’t a good candidate for the pump due to a probable lung met, so I don’t have anything to add about that unfortunately. But surgically in general he and his team were great and I think you will be in good hands.
DX 6/2017, 37yo father of two
Stage IIIb rectal cancer (T3N1bM0) no genetic indicators, normal CEA
7/2017 radiation + 5FU
10/2017 LAR w/ temp loop ileo. clear margins, 2/33 nodes
11/2017-3/2018 FOLFOX, 9 rounds
2/2018 clear CT
4/2018 ileo reversal
10/2018 CT shows suspicious mass in liver (1.7 cm), and in lung (0.6 cm)
MRI confirms 1 liver met, Stage IV
11/2018 liver resection, clear margins
1/2019 CT: lung node shrank to 0.3 cm

heiders33
Posts: 336
Joined: Sat Nov 04, 2017 11:08 am

Re: Hospitals that install HAI pump?

Postby heiders33 » Mon Dec 31, 2018 12:24 am

I have the Medtronic pump. I think I somehow slipped in before that trial started, because I don’t have the old Codman catheter. Not exactly sure how that happened. But anyways, the trial seems to be kind of a formality. It’s perfectly safe (notwithstanding the usual pump risks).
36 year-old female
May 2017: Dx rectal cancer T3N2M0
MSS, KRAS G12D
6/17: 28 days chemorad
9/17: LAR/loop ileostomy
10/17 - 2/18: XELOX six rounds
3/18: reversal
5/18: CT liver spot, blood counts normal
8/18: Abnormal PET, CEA 2.4
9/18: liver resection/HAI pump
10/18: Clear CT/sigmoidoscopy
10/18 - 4/19: 6MO FUDR/5FU

mpbser
Posts: 746
Joined: Wed Apr 19, 2017 11:52 am

Re: Hospitals that install HAI pump?

Postby mpbser » Mon Dec 31, 2018 7:32 am

How do you know it's perfectly safe? It's a brand new adaptation that hasn't been used on/in more than a handful of people yet.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0, 2.9, 2.2
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI shows met
Resection & HAI Mar 7

heiders33
Posts: 336
Joined: Sat Nov 04, 2017 11:08 am

Re: Hospitals that install HAI pump?

Postby heiders33 » Mon Dec 31, 2018 8:41 am

I guess I’m just going off what Kemeny/Kingham told me. If you are concerned about it, you should definitely ask them and get their reaction firsthand. I can’t really speak from my own experience because I don’t have the Codman catheter. But my impression from Kemeny is that it’s a trial driven by Medtronic and not something that she is particularly concerned about.
36 year-old female
May 2017: Dx rectal cancer T3N2M0
MSS, KRAS G12D
6/17: 28 days chemorad
9/17: LAR/loop ileostomy
10/17 - 2/18: XELOX six rounds
3/18: reversal
5/18: CT liver spot, blood counts normal
8/18: Abnormal PET, CEA 2.4
9/18: liver resection/HAI pump
10/18: Clear CT/sigmoidoscopy
10/18 - 4/19: 6MO FUDR/5FU

mpbser
Posts: 746
Joined: Wed Apr 19, 2017 11:52 am

Re: Hospitals that install HAI pump?

Postby mpbser » Mon Dec 31, 2018 4:14 pm

Someone on a Facebook colon cancer stage IV group just mentioned that the there have been some issues with the trial pump. I wish I had more information. This is very unnerving, when perhaps the best chance for a cure is now a non-FDA approved adapted device under trial. UGH! I wish I could get my hands on a Codman pump!!!!
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0, 2.9, 2.2
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI shows met
Resection & HAI Mar 7

mpbser
Posts: 746
Joined: Wed Apr 19, 2017 11:52 am

Re: Hospitals that install HAI pump?

Postby mpbser » Mon Dec 31, 2018 4:44 pm

OK, here is what I have been told: "my liver surgeon is from XYZ and he was coordinating a possible HAI pump with a colleague who does them from ABC. He looked everywhere to try get me a Codman pump and of course there are none available. I didn’t get specifics but he said they are having more problems with the Medtronic pump than MSK is admitting to and advised against it at this time. I know some are having problems with the chemo reaching the entire liver."

*SIGH* Great.... I will keep probing.....
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0, 2.9, 2.2
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI shows met
Resection & HAI Mar 7

User avatar
juliej
Posts: 2923
Joined: Thu Aug 05, 2010 12:59 pm

Re: Hospitals that install HAI pump?

Postby juliej » Mon Dec 31, 2018 5:44 pm

mpbser wrote:How do you know it's perfectly safe? It's a brand new adaptation that hasn't been used on/in more than a handful of people yet.

My MSKCC liver surgeon has implanted the new Medtronic pumps for several months now. I specifically asked him if the surgery was more difficult. He said there's no issue there, the issue is with maintenance because it requires a bit more skill than the Codman. It has a separate external unit that is used to program the pump to adjust the chemo and oncology nurses have to learn to use it. He said the pump is performing well though and he's implanted many of them now.

I agree that the clinical trial is a formality to get the pump approved for liver mets since Medtronic originally designed it as a pain pump. MSK would not use anything they felt was even remotely dangerous for the patient. Codman is the bad guy in this scenario. It is the norm to allow a long period of time before discontinuing a medical device, but Codman literally decided to stop production with a few weeks notice. It wasn't only MSK who was left in the lurch - about a dozen other cancer centers had just started HAI programs shortly before this happened. Everyone was left scrambling. Codman's only response was that it wasn't a money maker for them. My response to that is "charge more money for it then, but don't leave patients high and dry. It's simply unethical."

chadwick1 wrote:I saw the name mentioned and just wanted to say I had a liver resection with Dr. Kingham last month and it went really well. Both he and my onc agreed I wasn’t a good candidate for the pump due to a probable lung met, so I don’t have anything to add about that unfortunately. But surgically in general he and his team were great and I think you will be in good hands.

Chadwick, I'm confused why your liver was resected but they didn't implant the pump at the same time. I had a met in each of my lungs and still got the pump. Hopefully your liver will stay clear in your next scans, but if you have a recurrence, get a consultation with Dr. Kemeny about the pump.

Juliej
Stage IV, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/11
LAR, liver resec, HAI pump 11/11
Double lung surgery + ileo reversal 2/12
Adjuvant Xeloda 3-9/12
VATS rt. lung 12/21/12 - benign granuloma!
NED 3/17/12 to 2/1/2019, CEA<1

mpbser
Posts: 746
Joined: Wed Apr 19, 2017 11:52 am

Re: Hospitals that install HAI pump?

Postby mpbser » Mon Dec 31, 2018 6:07 pm

Thanks, julie! Perhaps the servicing is where the issues with the Medtronic lie. Appreciate the input!!!
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0, 2.9, 2.2
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI shows met
Resection & HAI Mar 7

heiders33
Posts: 336
Joined: Sat Nov 04, 2017 11:08 am

Re: Hospitals that install HAI pump?

Postby heiders33 » Mon Dec 31, 2018 6:33 pm

mpbser wrote:OK, here is what I have been told: "my liver surgeon is from XYZ and he was coordinating a possible HAI pump with a colleague who does them from ABC. He looked everywhere to try get me a Codman pump and of course there are none available. I didn’t get specifics but he said they are having more problems with the Medtronic pump than MSK is admitting to and advised against it at this time. I know some are having problems with the chemo reaching the entire liver."

*SIGH* Great.... I will keep probing.....


A liver surgeon in our Facebook group cleared this up. He said that the issue with chemo not reaching the whole liver is an anatomy issue, not a pump issue. I believe he posted about this in either the Liver Mets group or the HAI pump group, maybe cartech remembers. Or you can search for Paul Wright’s posts.

Thanks Julie for providing more expertise than I can! Sometimes I feel like I’m just repeating what I hear but I don’t always know what’s behind it. All I know is that I’ve had the Medtronic for a few months with zero issues.
36 year-old female
May 2017: Dx rectal cancer T3N2M0
MSS, KRAS G12D
6/17: 28 days chemorad
9/17: LAR/loop ileostomy
10/17 - 2/18: XELOX six rounds
3/18: reversal
5/18: CT liver spot, blood counts normal
8/18: Abnormal PET, CEA 2.4
9/18: liver resection/HAI pump
10/18: Clear CT/sigmoidoscopy
10/18 - 4/19: 6MO FUDR/5FU

User avatar
juliej
Posts: 2923
Joined: Thu Aug 05, 2010 12:59 pm

Re: Hospitals that install HAI pump?

Postby juliej » Mon Dec 31, 2018 7:02 pm

heiders33 wrote:A liver surgeon in our Facebook group cleared this up. He said that the issue with chemo not reaching the whole liver is an anatomy issue, not a pump issue. I believe he posted about this in either the Liver Mets group or the HAI pump group, maybe cartech remembers. Or you can search for Paul Wright’s posts.

Thanks Julie for providing more expertise than I can! Sometimes I feel like I’m just repeating what I hear but I don’t always know what’s behind it. All I know is that I’ve had the Medtronic for a few months with zero issues.

That's why all patients at MSKCC undergo hepatic arteriography using CT angiography to define your particular hepatic arterial anatomy before implanting the pump. Then they can tell if the chemo in the pump will reach all parts of the liver. However, some patients with anatomical variants that would technically make them illegible for the HAI pump can get it anyway if the surgeon determines that small vessels can be tied off to allow for proper perfusion.

People forget how important individual anatomy is to surgery and they also forget that there are many anatomical variations among humans, such as an accessory (extra) spleen or an extra rib (cervical rib), among others. We don't have cookie cutter bodies! :D

Juliej
Stage IV, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/11
LAR, liver resec, HAI pump 11/11
Double lung surgery + ileo reversal 2/12
Adjuvant Xeloda 3-9/12
VATS rt. lung 12/21/12 - benign granuloma!
NED 3/17/12 to 2/1/2019, CEA<1

cartech78
Posts: 54
Joined: Thu Oct 25, 2018 6:22 pm

Re: Hospitals that install HAI pump?

Postby cartech78 » Mon Dec 31, 2018 11:28 pm

mpbser wrote:Thanks, julie! Perhaps the servicing is where the issues with the Medtronic lie. Appreciate the input!!!

What Heiders wrote is correct! The surgeon from spectrum Health in Grand Rapids Michigan, his name is Paul Wright cleared up a lot of rumors about the pump. 1 the pump is already FDA approved but using whatever catheter they are using is not, hence the trial! Makes since if you think about it because insurance wouldn’t cover it most likely if it wasn’t FDA approved. 2. He is a believer in the pump because it’s effective and knows it can help some. 3. The profusion problems he has seen have all been due to abnormal anatomy. The pump doesn’t help everyone and a few it actually had put into liver failure by csusing damage to the bile ducts. Those were with the codman by the way, the new one can do it to though. Unfortunately it wont get everyone to resection and can even hurt a small percentage of people. For my own situation its a risk im willing to take as im not sure Chemo alone can get me to surgery.
40 Y/o male
Dx 10/5/18 stage lV CRC
Sg colon T3N1bM1a
Histologic grade-G2
7 inoperable liver mets largest 4.5 cm
Colon resection 10/6/18 clean margins
Starting FolFox on 11/12/18 3rnds
Report back to MSK on 12/18/18 for further instructions.

cartech78
Posts: 54
Joined: Thu Oct 25, 2018 6:22 pm

Re: Hospitals that install HAI pump?

Postby cartech78 » Mon Dec 31, 2018 11:34 pm

chadwick1 wrote:I saw the name mentioned and just wanted to say I had a liver resection with Dr. Kingham last month and it went really well. Both he and my onc agreed I wasn’t a good candidate for the pump due to a probable lung met, so I don’t have anything to add about that unfortunately. But surgically in general he and his team were great and I think you will be in good hands.

Thanks Chadwick! That makes me feel good! I have not heard anything bad about Dr.Kingham yet and it hasn’t been for a lack of asking! It makes you feel better when you know your with one of the best.
40 Y/o male
Dx 10/5/18 stage lV CRC
Sg colon T3N1bM1a
Histologic grade-G2
7 inoperable liver mets largest 4.5 cm
Colon resection 10/6/18 clean margins
Starting FolFox on 11/12/18 3rnds
Report back to MSK on 12/18/18 for further instructions.

mpbser
Posts: 746
Joined: Wed Apr 19, 2017 11:52 am

Re: Hospitals that install HAI pump?

Postby mpbser » Tue Jan 01, 2019 8:02 am

Wow! You guys are so awesome! Thanks so much for this information. Have a wonderful New Year, today and all of 2019!!!
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0, 2.9, 2.2
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI shows met
Resection & HAI Mar 7

chadwick1
Posts: 23
Joined: Sat Oct 13, 2018 9:04 am

Re: Hospitals that install HAI pump?

Postby chadwick1 » Tue Jan 01, 2019 8:49 pm

juliej wrote:Chadwick, I'm confused why your liver was resected but they didn't implant the pump at the same time. I had a met in each of my lungs and still got the pump. Hopefully your liver will stay clear in your next scans, but if you have a recurrence, get a consultation with Dr. Kemeny about the pump.

Hi Julie, thanks, that’s really interesting to hear! I’m not sure but looking at your sig I wonder if perhaps the protocol has changed since then? I’m seeing a different onc at MSK and we were a bit skeptical at first when she said I wouldn’t be a good candidate, but we asked Kingham about it too and he said the same thing: the lung met would mean systemic chemo and that would be a contra-indication for the pump. I won’t pretend to fully understand why medically but they both were pretty unequivocal. Certainly if this scan or another shows more liver recurrence I’ll be bringing it back up!
DX 6/2017, 37yo father of two
Stage IIIb rectal cancer (T3N1bM0) no genetic indicators, normal CEA
7/2017 radiation + 5FU
10/2017 LAR w/ temp loop ileo. clear margins, 2/33 nodes
11/2017-3/2018 FOLFOX, 9 rounds
2/2018 clear CT
4/2018 ileo reversal
10/2018 CT shows suspicious mass in liver (1.7 cm), and in lung (0.6 cm)
MRI confirms 1 liver met, Stage IV
11/2018 liver resection, clear margins
1/2019 CT: lung node shrank to 0.3 cm


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