How crucial is the HAI pump?

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TinaFish
Posts: 178
Joined: Sun Jul 21, 2019 10:11 am

How crucial is the HAI pump?

Postby TinaFish » Tue Aug 06, 2019 10:55 am

I'm thinking I might need one... and fast. I have inoperable liver mets. Any reason for me not to get one? I don't know why my oncologist is taking such a laid-back approach by just giving me chemo. Maybe she has no hope for me??
F 45, single mother to son, 7 and daughter, 3
DX: stage 4 Rectal Cancer June 2019
Tumor Location: ? cm above anal verge
Tumor type: Adenocarcinoma
Tumor size: 5 cm
Tumor grade: ?
TNM code: ?
Stage : Stage IV-B
# of cancerous lymph nodes: ?
Mets: Numerous mets to liver, lungs
CEA: 22 in July; 11 as of August 15, 7 as of Sept 20
MSI status: MSS
KRAS/BRAF status: KRAS mutation
surgery: TBD
Ostomy surgery: TBD
Radiation therapy: TBD
Chemotherapy : CAPEOX+Avastin, 6 cycles, with CT scans after 3rd and 6th cycle.

radnyc
Posts: 388
Joined: Tue Apr 06, 2010 6:32 pm

Re: How crucial is the HAI pump?

Postby radnyc » Tue Aug 06, 2019 11:03 am

The pump has been shown to be very effective at shrinking liver tumors and allow patients to get to resection and also to keep tumors from coming back after liver resection. I strongly suggest, if you haven’t already, to make an appointment at MSKCC, you need the best people taking care of you.
DX Jan '10, at 47
Feb - colon resection - 2/17 nodes
April - liver mets - Stage 4
3 months Folfox chemotherapy
August '10 liver resection and HAI pump
7 months chemo FUDR HAI and Folfiri systemic
NED since August 2010
Last treatment April '11
HAI Pump removed Dec '15

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ginabeewell
Posts: 313
Joined: Wed Oct 24, 2018 10:30 am

Re: How crucial is the HAI pump?

Postby ginabeewell » Tue Aug 06, 2019 11:23 am

If you think you have any interest in pursuing this at all, I would go right now.

I didn't realize in my own situation that I would have such a small window for the pump to do its job, so I did chemo for about two months (Oct - Dec) until an infection set in, and then I had to do a chemo break. It's at that point that I told my oncologist I wanted to do a consult with MSK and pursue the pump.

I think by the time I got HAI pump installed (late March), I had been given about 8 rounds of chemo - FOLFOX and Vectibix - and the pump didn't shrink my mets at all any further once it went in (although we think now that it did help to kill the active cancer cells).

Thankfully my initial rounds of chemo were enough to get me to resectable, and I just had my first of two liver resections. But in retrospect I wish I would have pursued the pump more aggressively from the very beginning. If you are inoperable and want to pursue, do it ASAP.
45 year old mom of twins (8) and lucky stepmom of 14 and 16 year olds
9/17/18 DX stage 4 CRC w inoperable liver mets
9/20/18 CEA 931
10/1/18 FOLFOX + Vectibix planned 12 rounds
12/12/18 CT scan showed typhlitis (7 days in hospital) but largest met down to 5 cm. Chemo holiday.
12/26/18 CEA 4.6
1/14/18 Resume chemo (#6-8)
3/27/19 HAI pump placement / colon resection
4/8/19 Resume chemo (#9-19) FOLFOX (no OX) + Vectibix
5/20/19 CEA 1.3
7/19/19 1st liver resection
10/16/19 2nd liver resection

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Jacques
Posts: 518
Joined: Sun Dec 28, 2014 10:38 am
Location: Occitanie

Re: How crucial is the HAI pump?

Postby Jacques » Tue Aug 06, 2019 12:31 pm

ginabeewell wrote:If you think you have any interest in pursuing this at all, I would go right now....If you are inoperable and want to pursue, do it ASAP.

There's another reason for doing it ASAP, and that is that the company that makes the main pump used at MSKCC has decided to halt production of that pump, and there may not be that many of those HAI pumps left in stock. You can read about the problem here:

Halt in Production of Codman Pump Leaves Questions: Page 2 of 3
Nancy E. Kemeny, MD

https://www.cancernetwork.com/colorectal-cancer/halt-production-codman-pump-leaves-questions/page/0/1

kandj
Posts: 260
Joined: Sun Sep 27, 2015 11:29 am

Re: How crucial is the HAI pump?

Postby kandj » Tue Aug 06, 2019 12:49 pm

Jacques wrote:
ginabeewell wrote:If you think you have any interest in pursuing this at all, I would go right now....If you are inoperable and want to pursue, do it ASAP.

There's another reason for doing it ASAP, and that is that the company that makes the main pump used at MSKCC has decided to halt production of that pump, and there may not be that many of those HAI pumps left in stock. You can read about the problem here:


I am pretty sure they are out of Codman pumps. Most new patients I have spoken to when we go with DH to appointments have the new pump.
wife to DH, dx 8/15 stage IV @36, numerous unresectable liver Mets
resection and HAI placed 12/15
Liver resection 5/19/2016 15-20 mets removed (surgeon lost count, but it hopeful he got it all!)
Recurrence 7/2017 4 Liver mets and one possible lung met
Radiation on liver Mets 12/17
Lung met 10/18
VATS on lung met 11/18 started xeloda
chemo break, nothing seen on scans 6/19 or 8/19 Hopeful

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ginabeewell
Posts: 313
Joined: Wed Oct 24, 2018 10:30 am

Re: How crucial is the HAI pump?

Postby ginabeewell » Tue Aug 06, 2019 2:38 pm

kandj wrote:
I am pretty sure they are out of Codman pumps. Most new patients I have spoken to when we go with DH to appointments have the new pump.


That is correct. Patients are now getting the Medtronic pump installed, the Codman pumps are long gone...
45 year old mom of twins (8) and lucky stepmom of 14 and 16 year olds
9/17/18 DX stage 4 CRC w inoperable liver mets
9/20/18 CEA 931
10/1/18 FOLFOX + Vectibix planned 12 rounds
12/12/18 CT scan showed typhlitis (7 days in hospital) but largest met down to 5 cm. Chemo holiday.
12/26/18 CEA 4.6
1/14/18 Resume chemo (#6-8)
3/27/19 HAI pump placement / colon resection
4/8/19 Resume chemo (#9-19) FOLFOX (no OX) + Vectibix
5/20/19 CEA 1.3
7/19/19 1st liver resection
10/16/19 2nd liver resection

mpbser
Posts: 927
Joined: Wed Apr 19, 2017 11:52 am

Re: How crucial is the HAI pump?

Postby mpbser » Tue Aug 06, 2019 2:39 pm

There are no Codman pumps remaining at MSK. I know that for a fact.
Wife 4/17 Dx age 45
5/17 LAR
Adenocarcinoma
low grade
1st primary T3 N2b M1a
Stage IVA
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
MSS
Lynch no; KRAS wild
Immunohistochemsistry Normal
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles
NED

jens22
Posts: 1008
Joined: Wed Jun 09, 2010 9:26 am
Facebook Username: jspirio
Location: Long Island, NY

Re: How crucial is the HAI pump?

Postby jens22 » Tue Aug 06, 2019 2:49 pm

Call MSK and get a consult ASAP you have nothing to lose.
Colonoscopy 3/10 for ? hemmorrhoid.
Diag Colon Cancer 3 days later
Colon Ressection 3/30/10
Stage 3B 5/14 Nodes positive.
Power Port and 7 months of Chemo
Port removed 11/11
8 negative Cat Scans..... 7 years cancer free and Discharged from Sloane Kett!!
Diag age 47 , now 54 Mom of 3 boys.

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juliej
Posts: 3048
Joined: Thu Aug 05, 2010 12:59 pm

Re: How crucial is the HAI pump?

Postby juliej » Tue Aug 06, 2019 6:48 pm

Agree with others - call MSK and get a consultation about the HAI pump asap!

How crucial is it? Well, it depends on your stage. I was a Stage 4 patient with mets to all lobes of my liver and a large met in the bottom of each lung. For me, the HAI pump was the difference between having a chance to survive and being written off by my local cancer center as another hopeless Stage 4. I would recommend it (and MSK) to anyone who has extensive liver mets. Your odds of achieving long-term NED (no evidence of disease) status increases dramatically if the HAI pump can get your liver to a resectable state.

Juliej
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 9/23/2019, CEA<1

TinaFish
Posts: 178
Joined: Sun Jul 21, 2019 10:11 am

Re: How crucial is the HAI pump?

Postby TinaFish » Tue Aug 06, 2019 11:32 pm

Ok! Thanks so much for the feedback!! Any reason for me not to do it at City of Hope (much closer to me) instead of MSK? Do you think the doctors at City of Hope wouldn't be as good?

Would I need a referral from my oncologist to go to either City of Hope or MSK?

And also, I have Medi-Cal insurance. I'm pretty sure they won't pay for procedures done outside of California, right? So if I did need to go to MSK and pay out-of-pocket, I wonder what it would cost... not that you can ever put a price on your life. I would pay anything to be able to beat this evil.
F 45, single mother to son, 7 and daughter, 3
DX: stage 4 Rectal Cancer June 2019
Tumor Location: ? cm above anal verge
Tumor type: Adenocarcinoma
Tumor size: 5 cm
Tumor grade: ?
TNM code: ?
Stage : Stage IV-B
# of cancerous lymph nodes: ?
Mets: Numerous mets to liver, lungs
CEA: 22 in July; 11 as of August 15, 7 as of Sept 20
MSI status: MSS
KRAS/BRAF status: KRAS mutation
surgery: TBD
Ostomy surgery: TBD
Radiation therapy: TBD
Chemotherapy : CAPEOX+Avastin, 6 cycles, with CT scans after 3rd and 6th cycle.

Rock_Robster
Posts: 340
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: How crucial is the HAI pump?

Postby Rock_Robster » Tue Aug 06, 2019 11:38 pm

I can only comment on the first part but City of Hope is highly reputable, and also has some of the foremost liver surgeons in the world (eg Dr Fong, formerly MSK). If I was west coast I’d happily be at CoH. If I was already east coast then MSK makes sense. Just one guy’s opinion though; there’s a lot of MSK/Kemeny fans out there too.

https://www.cityofhope.org/people/fong-yuman
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

cartech78
Posts: 65
Joined: Thu Oct 25, 2018 6:22 pm

Re: How crucial is the HAI pump?

Postby cartech78 » Wed Aug 07, 2019 12:25 am

Go right away for the pump like the others have said! I got mine put in on 3/6/19 . I was originally supposed to have a partial liver resection at the same time but they found an additional 20 tumors the scans didn’t show when they went in fora total of 27 tumors. My surgeon (Dr.Kingham) at MSK closed me up after seeing that and didn’t do the resection. I had a PET scan on Monday after 6 treatments with the pump and doing systemic and it looks like I had a complete response from it. They are saying I don’t even need a liver resection now. The studies show the pump to be more effective if you get it while still in your first line of treatment also this will give you access to better liver surgeons who may have a completely different opinion on if your resectable or not yet. Good luck and by the way don’t stop if one place declines you for HAI pump. Keep looking at other hospitals that do it in that scenario. We have a list from another group of known hospitals that do the Medtronic version as the Codman pump is no more!
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 11/18
2nd opinion at MSK on 12/18
HAI pump installed on 3/6/2018 also found 20 more small tumors on liver scans missed
7/2/2018 MRI and CT show only 2 liver tumors visible and they are shrunk by 3/4
8/5/2018- Pet scan- Dr.Kemeny and Dr.Kingham think ive had complete response from pump. Want me to do a little more chemo to be safe.

TinaFish
Posts: 178
Joined: Sun Jul 21, 2019 10:11 am

Re: How crucial is the HAI pump?

Postby TinaFish » Wed Aug 07, 2019 1:01 pm

cartech78 wrote:Go right away for the pump like the others have said! I got mine put in on 3/6/19 . I was originally supposed to have a partial liver resection at the same time but they found an additional 20 tumors the scans didn’t show when they went in fora total of 27 tumors. My surgeon (Dr.Kingham) at MSK closed me up after seeing that and didn’t do the resection. I had a PET scan on Monday after 6 treatments with the pump and doing systemic and it looks like I had a complete response from it. They are saying I don’t even need a liver resection now. The studies show the pump to be more effective if you get it while still in your first line of treatment also this will give you access to better liver surgeons who may have a completely different opinion on if your resectable or not yet. Good luck and by the way don’t stop if one place declines you for HAI pump. Keep looking at other hospitals that do it in that scenario. We have a list from another group of known hospitals that do the Medtronic version as the Codman pump is no more!


Wait, you had your colon resection one day after you got diagnosed??
F 45, single mother to son, 7 and daughter, 3
DX: stage 4 Rectal Cancer June 2019
Tumor Location: ? cm above anal verge
Tumor type: Adenocarcinoma
Tumor size: 5 cm
Tumor grade: ?
TNM code: ?
Stage : Stage IV-B
# of cancerous lymph nodes: ?
Mets: Numerous mets to liver, lungs
CEA: 22 in July; 11 as of August 15, 7 as of Sept 20
MSI status: MSS
KRAS/BRAF status: KRAS mutation
surgery: TBD
Ostomy surgery: TBD
Radiation therapy: TBD
Chemotherapy : CAPEOX+Avastin, 6 cycles, with CT scans after 3rd and 6th cycle.

cartech78
Posts: 65
Joined: Thu Oct 25, 2018 6:22 pm

Re: How crucial is the HAI pump?

Postby cartech78 » Wed Aug 07, 2019 3:24 pm

TinaFish wrote:
cartech78 wrote:Go right away for the pump like the others have said! I got mine put in on 3/6/19 . I was originally supposed to have a partial liver resection at the same time but they found an additional 20 tumors the scans didn’t show when they went in fora total of 27 tumors. My surgeon (Dr.Kingham) at MSK closed me up after seeing that and didn’t do the resection. I had a PET scan on Monday after 6 treatments with the pump and doing systemic and it looks like I had a complete response from it. They are saying I don’t even need a liver resection now. The studies show the pump to be more effective if you get it while still in your first line of treatment also this will give you access to better liver surgeons who may have a completely different opinion on if your resectable or not yet. Good luck and by the way don’t stop if one place declines you for HAI pump. Keep looking at other hospitals that do it in that scenario. We have a list from another group of known hospitals that do the Medtronic version as the Codman pump is no more!


Wait, you had your colon resection one day after you got diagnosed??


Yes! It was 98% blocked so i had to have an emergency surgery to remove the tumor.
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 11/18
2nd opinion at MSK on 12/18
HAI pump installed on 3/6/2018 also found 20 more small tumors on liver scans missed
7/2/2018 MRI and CT show only 2 liver tumors visible and they are shrunk by 3/4
8/5/2018- Pet scan- Dr.Kemeny and Dr.Kingham think ive had complete response from pump. Want me to do a little more chemo to be safe.

Ehut
Posts: 209
Joined: Wed Sep 26, 2012 4:24 pm
Location: Algonquin, IL

Re: How crucial is the HAI pump?

Postby Ehut » Wed Aug 07, 2019 4:11 pm

Sadly, I believe many oncologists just go through the motions when the tumors are inoperable and don't pursue aggressive treatment like I think they should in some cases. Fortunately I was operable and didn't need the pump, but if I were in your situation, I would DEFINITELY pursue one.
Dx 12/11 rectal stage IV w/ 6 mets to liver, age 35
4 cycles FOLFOX 12/11 to 2/12
short course radiation 2/12
rectal/liver resection 3/12, temp ileostomy
8 cycles FOLFOX/FOLFIRI 4/12 to 8/12
ileostomy reversal 10/12
port out 10/13
NED for 7+ years and counting!


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