hiker wrote:Hey Rock,
Obviously you have to do what feels right to you and the plan doesn't sound bad. However, any oncologist who says HAI is “old technology which is not really beneficial since we’ve had platinum-based chemo drugs” is completely full of crap and I honestly can't take them seriously. Maybe it just touches a nerve with me since one of the oncologists I saw before I went to MSK told me the same thing - his plan was chemo for life which wouldn't be more than two years. HAI pumps have been preventing recurrences after surgery and getting people who are inoperable to operable for decades.
You say you were looking for the most aggressive treatment possible - I believe HAI is just that. It's unfortunate that so many oncologists talk it down. One question for your oncologist - how many stage iv patients has he treated who are alive after 5 years and 10 years? Dr. Kemeny at MSK is hitting on 80% and 60%, respectively, which is outstanding.
The treatment plan looks appropriately aggressive. But yes, hiker is correct. Your oncologist is simply ignorant of HAI. Not really a knock (other than he should just admit it, rather than spread disinformation), as he's far from alone. Oncologists offer what they know. Most don't know HAI.
Ironically, Dr. Kemeny was lead researcher for oxaliplatin. Without her, there might not be FOLFOX, the most common platinum-based chemo for CRC. And yet, she still does HAI.
Here's the common misconception about HAI amongst oncologists: That it doesn't improve overall survival. This was based on a trial which had two groups, both with liver-limited disease: One that was treated with systemic chemo only, and one that was treated with HAI only. The group with systemic chemo, their livers ultimately failed, as systemic chemo alone is not enough to rid the liver of mets. The HAI group treated the liver well, but the pump doesn't help prevent spread (which is what systemic chemo does). So both groups had similar survival rates. The conclusion drawn was that there was no net benefit to HAI, as patient survival wasn't improved with it. Therefore, why make the effort to learn such a costly and labor-intensive procedure?
What Dr. Kemeny figured out, is that it's not an either/or scenario. To give the patient the best chance at NED, you should do BOTH. HAI and systemic together. That's what's resulted in the improved patient outcomes for those who get the treatment from dedicated HAI programs.
As you are currently resectable, you may not need a pump (and as your oncologist knows nothing about it, I wouldn't trust him to put on in, anyway). However, it is proven to be effective adjuvant therapy, post-resection. Whatever you decide to do, I wish you the best.