How crucial is the HAI pump?

[TinaFish]

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??

[radnyc]

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.

[ginabeewell]

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.

[Jacques]

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]

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.

[ginabeewell]

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...

[mpbser]

There are no Codman pumps remaining at MSK. I know that for a fact.

[jens22]

Call MSK and get a consult ASAP you have nothing to lose.

[juliej]

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

[TinaFish]

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.

[Rock_Robster]

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

[cartech78]

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!

[TinaFish]

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??

[cartech78]

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.

[Ehut]

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.