Pump people recurrence question

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ginabeewell
Posts: 100
Joined: Wed Oct 24, 2018 10:30 am

Re: Pump people recurrence question

Postby ginabeewell » Sat Feb 09, 2019 12:43 pm

mpbser wrote:It is correct. I just spoke with her yesterday about it.


Strange. Wonder if that's driven by her confidence in specific centers vs others? Sounds like she is pretty tight with the surgeon at NW who runs their pump program. At any rate, maybe this will change over the next few years if other centers get aggressive about developing their programs.
45 year old mom of twins (7) and lucky stepmom of 13 and 15 year olds
9/11/18 colonoscopy
9/17/18 DX stage 4 CRC with inoperable liver metastasis (largest 11 cm)
9/20/18 CEA 931
10/1/18 FOLFOX + Vectibix planned 12 rounds
12/12/18 Routine scan picked up typhlitis - hospital stay for 7 days - but largest met down to 5 cm. Chemo holiday.
12/26/18 CEA 4.6!
1/14/18 Resume chemo (round #6), FOLFOX hold the Vectibix
2/18/18 Return to MSK post 2 more rounds to see if ready for liver resection / HAI pump placement

mpbser
Posts: 684
Joined: Wed Apr 19, 2017 11:52 am

Re: Pump people recurrence question

Postby mpbser » Sat Feb 09, 2019 12:49 pm

From what I understand, the maintenance of the Medtronic requires far more skill. It is "more difficult to find the infusion point." Not exactly sure what that means. She did say that she might know someone who can service it for us in Boston but she didn't realize we live equidistant to Boston as to Westchester.
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??

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LPL
Posts: 519
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Pump people recurrence question

Postby LPL » Sat Feb 09, 2019 1:07 pm

I have heard that there is a HAI trial in Europe (The Neatherlands). It looks like they are doing it in 4 different places/Hospitals. So does that mean a lot of people there have learned how to do this maintenance?
https://dccg.nl/trial/pump-trial
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

hiker
Posts: 130
Joined: Thu Aug 09, 2018 10:15 am

Re: Pump people recurrence question

Postby hiker » Sat Feb 09, 2019 1:08 pm

mpbser wrote:I spoke with my aunt who has been a nurse for 47 years this morning about our situation. When I told her that MSK has implanted this pump/adaptation implanted in about 60 patients so far and the trial started this past summer, she was extremely negative about going through with it. She kept saying SIXTY?! ONLY SIXTY?! and asking if my husband wanted to be a guinea pig over and over and over.

Sigh.


Someone has to be the pioneer or we'd never have any advances.

hiker
Colonoscopy 2/17, 5cm tumor descending
Diagnosed stage iv, liver mets 3/17
Colon resection 3/17
Told surgery not an option, get my affairs in order
Meet w/MSK team 5/01/17
Folfox(3rds) 5/17-6/17
Liver resection/implant HAI pump 7/17
HAI pump chemo(5rds) 8/17-2/18
Folfiri+Vectibix(11rds) 8/17-2/18
Spot on chest CT 10/17
Lung biopsy (that was fun) 11/17
Nocardia bacterial infection w/spread to brain (this is serious) 11/17
IV antibiotics 12/17-2/18
Oral antibiotics 3/18-12/18
Clear of cancer since surgery

mpbser
Posts: 684
Joined: Wed Apr 19, 2017 11:52 am

Re: Pump people recurrence question

Postby mpbser » Sat Feb 09, 2019 1:51 pm

LPL, I looked at the website that linked from the website you provided. I see that the pump being shown there is a German product called "tricumed." https://www.chemopomp.nl/ It is not the same pump as the only one currently available in the US, the Medtronic-Codman adaptation under trial at MSK (and being implanted "off label" at other places). However, it COULD be the Medtronic-Codman adaptation simply renamed. I don't know anything about European medical device law.
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: 684
Joined: Wed Apr 19, 2017 11:52 am

Re: Pump people recurrence question

Postby mpbser » Sat Feb 09, 2019 1:57 pm

Actually, upon further review of the website, it looks like it is definitely not the Medtronic-Codman adaptation. The site states, "The chemo pump has no battery but a gas that together with the body temperature provides the driving force for circulating chemotherapy." That is a description of the Codman pump, not the Medtronic which has a battery. Where the heck did they get this technology? VERY VERY interesting!
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
LPL
Posts: 519
Joined: Fri Apr 22, 2016 12:49 am
Location: Europe

Re: Pump people recurrence question

Postby LPL » Sat Feb 09, 2019 2:04 pm

mpbser wrote:Actually, upon further review of the website, it looks like it is definitely not the Medtronic-Codman adaptation. The site states, "The chemo pump has no battery but a gas that together with the body temperature provides the driving force for circulating chemotherapy." That is a description of the Codman pump, not the Medtronic which has a battery. Where the heck did they get this technology? VERY VERY interesting!

Wow, you are so good at finding things!! I went looking there to see what pump they used but I did not find that info! 8) :wink:
DH @ 65 DX 4/11/16 CC recto-sigmoid junction
Adenocarcenoma pt 35x15x9mm G3(biopsi) G1(surgical)
Mets 3 Liver resectable
T4aN1bM1a Stage IVa 2/9 LN
MSS, KRAS-mut G13D
CEA & CA19-9: 5/18 2.5 78 8/17 1.4 48 2/14/17 1.8 29
4 Folfox 6/15-7/30 (b4 liver surgery) 8 after
CT: 8/8 no change 3/27/17 NED for now :D
:!: Steroid induced hyperglycemia dx after 3chemo .. hospitalized, insulin -> Metformin
Surgeries (open):
3/18 Emergency colostomy 5/23 Primary+gallbl+colostomy reversal (+port) 9/01 Liver mets

mpbser
Posts: 684
Joined: Wed Apr 19, 2017 11:52 am

Re: Pump people recurrence question

Postby mpbser » Sat Feb 09, 2019 2:19 pm

I sent them a question that you might find helpful, LPL: Could you please tell me what maintenance is needed when the HAI FUDR treatment (usually six months) is finished? Is it every two weeks filling with saline or is it every 6-8 weeks fill with glycerol?

I will let you know what they say.

This looks to be a product of Servier, Amgen, and/or Merck.

Interestingly, Memorial Sloan Kettering's logo appears in the revolving banner at the bottom of https://www.chemopomp.nl/chemopomp
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
Maggie Nell
Posts: 941
Joined: Wed May 27, 2015 1:57 am
Location: Melbourne, Australia

Re: Pump people recurrence question

Postby Maggie Nell » Sat Feb 09, 2019 6:49 pm

mpbser wrote:I spoke with my aunt who has been a nurse for 47 years this morning about our situation. ..... she was extremely negative about going through with it. She kept saying SIXTY?! ONLY SIXTY?! and asking if my husband wanted to be a guinea pig over and over and over.

Sigh.


Hasn't your aunt retired from nursing by now? She must be in her 70s.... What was your husband's response to her.....is she
undermining his confidence?
DX April 2015, @ 54
35mm poorly diff. tumour, incidental finding following emergency r. hemicolectomy
for ileo-colic intussusception.
Lymph nodes: 0/22
T3 N0 MX

mpbser
Posts: 684
Joined: Wed Apr 19, 2017 11:52 am

Re: Pump people recurrence question

Postby mpbser » Sat Feb 09, 2019 9:39 pm

Yes, she retired but does some emergency medical management training for hospitals on a contractual basis from time to time to keep busy. I have kept her attitude about it to myself so my husband has nothing to which to respond. It only shakes me up and scares the living daylights out of me.
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: 684
Joined: Wed Apr 19, 2017 11:52 am

Re: Pump people recurrence question

Postby mpbser » Sat Feb 09, 2019 9:40 pm

Dr. Kemeny is 73, btw.
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
Maggie Nell
Posts: 941
Joined: Wed May 27, 2015 1:57 am
Location: Melbourne, Australia

Re: Pump people recurrence question

Postby Maggie Nell » Sat Feb 09, 2019 10:53 pm

mpbser wrote: It only shakes me up and scares the living daylights out of me.


Just like a martini in a James Bond movie, eh?

The way Dr Kemeny is spoken about in this forum, I have long received the impression she was ageless. No doubt
she is mentoring and guiding scores of junior doctors and passing down her decades of experience. More power to her.
DX April 2015, @ 54
35mm poorly diff. tumour, incidental finding following emergency r. hemicolectomy
for ileo-colic intussusception.
Lymph nodes: 0/22
T3 N0 MX

cbsmith
Posts: 87
Joined: Sat Nov 28, 2015 11:45 am
Location: New Brunswick, Canada

Re: Pump people recurrence question

Postby cbsmith » Mon Feb 11, 2019 7:05 am

Unfortunately it sounds like there are really only a couple options. Get Dr. K to implant the pump as part of her trial and hope it works on the liver Mets, which it appears to do for other people, and have the hassle of the maintenance of the pump after treatment, while hoping someone closer to home will service it in the future. Or skip the pump as it is a trial and have surgery and systemic chemo alone.

It sounds like the debate is because Dr. K is running a trial for the new pumps. Going back to the old pumps isn’t an option from what I have read so it looks like these new style pumps will be what she uses during and after her trial. My opinion would be to go the pump route but that is just me.
06/14-DX with FAP as 36yo Male
07/14-total colectomy, rectum removal, permanent ileostomy
08/14-DX Stage IIIC, KRAS mutant, MSS
09/14-04/15 - 12 rounds of FOLFOX
07/15-CT showed para-aortic lymph node, onc thght inflammation
10/15-DX Stage IV, CT lymph node tripled in size, 1 small lung met
11/15-FOLFIRI + Avastin
06/16-lymph node is stable, now have a 2nd lung met
01/16-lymph node is stable, lung mets grown 2mm. Still on FOLFIRI + Avastin
11/17 - no chemo since. Lung growth minimal, lymph node is stable

Pyro
Posts: 57
Joined: Mon Oct 12, 2015 7:40 pm
Location: Tucson, AZ

Re: Pump people recurrence question

Postby Pyro » Mon Feb 11, 2019 8:12 am

Maggie Nell wrote:
mpbser wrote: It only shakes me up and scares the living daylights out of me.


Just like a martini in a James Bond movie, eh?

The way Dr Kemeny is spoken about in this forum, I have long received the impression she was ageless.


I’m with you, a lot of trust in 1 person who isn’t getting any younger, but her knowledge isn’t secret or selfishly kept. I get it though, scary times and her name pops up when people deal with liver Mets. FWIW I had 13 tumors all over my liver, my local surgeon in a fairly large town told me he couldn’t do it, the tumors were too diffuse. MD Anderson surgeons had all the tumors out within 6 months, no pump necessary. There are different ways to skin the cat, and everyone’s disease is unique.
Aug 2015- Diag Stage 4 CC with mets to liver (38/m)
Sep 2015- Avastin/Folfox/Iron
Dec 2015-Not a surgery candidate for liver
Jan 2016- Erbitux/Folfiri, 2nd opinion at MDA in TX
Feb 2016 -MD Anderson liver surgery, Dr. Vauthey
Mar 2016 -30% of left lobe removed, PVE
May 2016 - 70% of liver removed
Jun 2016-Radiation
Jan 2017-permanent colost @ MDA
Jul 2017-Erb/FOLFURI
Nov 2017 -Lung & Liver ablations@MDA
Jan 2018 -Xeloda & Avastin mx
Jul 2018-Avast/FOLFURI
Sep 2018-Radiation
Chemo for life

User avatar
ginabeewell
Posts: 100
Joined: Wed Oct 24, 2018 10:30 am

Re: Pump people recurrence question

Postby ginabeewell » Mon Feb 11, 2019 12:13 pm

Just had an interesting interaction with my RN here at Northwestern. She was apparently the one who originally fielded my pump question on MyChart when I asked for an MSK / pump referral. Turns out she spent a year there working on Kemeny's team.

What she shared:
1) Kemeny is a genius
2) She's a workhorse - but a huge part of how she managed patient workload is the fact that she's assembled an amazing team. She doesn't work alone, and other MSK oncologists are just as aggressive with pump treatment.
3) She was glad that I reached out to ask about the pump and noted how surprised she was that I had done that research / how few patients do. She thinks I'm making the right decision to pursue.
4) She's surprised that NW doesn't do more pumps even though available here. The lead oncologist says they don't do it mainly because people don't ask. Wow. Maybe this will someday be my focus for patient advocacy.

Just thought I would share.
45 year old mom of twins (7) and lucky stepmom of 13 and 15 year olds
9/11/18 colonoscopy
9/17/18 DX stage 4 CRC with inoperable liver metastasis (largest 11 cm)
9/20/18 CEA 931
10/1/18 FOLFOX + Vectibix planned 12 rounds
12/12/18 Routine scan picked up typhlitis - hospital stay for 7 days - but largest met down to 5 cm. Chemo holiday.
12/26/18 CEA 4.6!
1/14/18 Resume chemo (round #6), FOLFOX hold the Vectibix
2/18/18 Return to MSK post 2 more rounds to see if ready for liver resection / HAI pump placement


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