Recent HAI Pump?

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crikklekay
Posts: 129
Joined: Thu Feb 15, 2018 9:47 am
Location: Richmond, VA

Recent HAI Pump?

Postby crikklekay » Wed Jun 09, 2021 1:05 pm

We just came back from John's surgeon consult about his liver met (assumed, they can't biopsy it so they're treating it as cancerous considering the CEA/history), and when he asked if we had any questions I inquired about the HAI pump. He looked absolutely dumbfounded and told me that "took him back to the 80s". He said it was a popular treatment but for the cost and complications it didn't really show much improvement in outcome and there are better techniques now. I was kind of floored considering how much I've read about it here. Has anyone recently gone through the HAI pump treatment? John may not even be a candidate since his tumor is small and he only has one (that might be akin to using a flame thrower when only a laser is needed), but I was curious if the surgeon is just really out of the loop.

Thankfully he isn't the end all be all of the treatment plan, there is a tumor board that is meeting tomorrow and will go over his case to discuss the best options for him. All the waiting is keeping me on edge, I just want him to be in treatment already so we can kick this thing's butt!
Caring for DH John
Stage IIIC, Lymph nodes: 6/22
Chemotherapy: FOLFOX (6)
12/17 ER and emergency surgery
02/18 Hospital w/MSSA infected port, PICC line inserted, chest CT scan showed septic emboli & blood clots
03/18 Hospital w/CDIFF
04/18 Chest CT scan clear
06/18 Colonoscopy Clear
08/18 CT Scan Clear, NEMD
2019/2021 Colonoscopy Clear
2019/2020/2021 CT Scan Clear
2021 PET scan shows activity on liver
2021 MRI confirms one spot on liver

Nor Cal
Posts: 17
Joined: Sun Dec 06, 2020 8:18 pm

Re: Recent HAI Pump?

Postby Nor Cal » Wed Jun 09, 2021 1:45 pm

I've had a similar response from two surgeons. I spoke recently to a surgeon from Stanford and he said that right now there isn't really a target on the right side of my liver (good news) and if the tumors start progressing then ablation is likely to be the targeted treatment of choice. I didn't get into the details but he didn't seem interested at all in an HAI pump.
Dx June 2020, stage IV, w liver mets in both lobes. M, age 50. Right-sided colon tumor. BRAF mutation. CEA 120
7-12/20 9 cycles FOLFOXIRI (plus Avastin cycles 2-6)
CEA 2.9
12/20 radioembolization (right lobe) cea 2.0
1/21 chemoembolization (left lobe)
2/21 chemoembolization (left lobe)
1-6/21 6 cycles FOLFIRI + Avastin

User avatar
ginabeewell
Posts: 500
Joined: Wed Oct 24, 2018 10:30 am

Re: Recent HAI Pump?

Postby ginabeewell » Thu Jun 10, 2021 12:35 am

My experience is that the only places you’ll get a positive reaction on the pump are the centers with expertise. And over time I have wondered if Kemenys pump success was as much or more just about her skill as an oncologist.

Personally if I wanted to know if the pump was the right option I would try to get a consult with Dr Fong at City of Angels or MSK.
45 YO mom of twins (9) and lucky stepmom of 14/17 year olds
9/17/18 DX stage 4 CRC w inoperable liver mets CEA 931
10/18 FOLFOX + Vectibix
12/18 typhlitis (7 days in hospital) but largest met down to 5 cm.
12/18 CEA 4.6
1/18 Resume chemo (#6-8)
3/19 HAI pump placement / colon resection
4/19 Resume chemo (#9-19) FOLFOX (no OX) + Vectibix
5/19 CEA 1.3
7/19 liver resection
10/19 liver resection
1/20 NED! CEA 0.6
3/20 two new liver mets; FOLFIRI (5) and then add Vectibix (5)
8/20 CEA 0.7
Resection next?

crikklekay
Posts: 129
Joined: Thu Feb 15, 2018 9:47 am
Location: Richmond, VA

Re: Recent HAI Pump?

Postby crikklekay » Thu Jun 10, 2021 10:17 am

I will admit his reaction did surprise me, considering how many people talk about it here. I haven't mentioned it to John's oncologist yet, I wonder if she would have a more positive opinion since wouldn't be looking at it from a surgical viewpoint? From what I've read, our local cancer center would need to coordinate with MSK or City of Angels on treatment so if she isn't keen on it I guess we'd have to find an oncologist who is, should it be deemed a good treatment for him. Thankfully, we have an NCI cancer center nearby we can go to for a second opinion as well. I guess we'll wait and see what the tumor board says for now.
Caring for DH John
Stage IIIC, Lymph nodes: 6/22
Chemotherapy: FOLFOX (6)
12/17 ER and emergency surgery
02/18 Hospital w/MSSA infected port, PICC line inserted, chest CT scan showed septic emboli & blood clots
03/18 Hospital w/CDIFF
04/18 Chest CT scan clear
06/18 Colonoscopy Clear
08/18 CT Scan Clear, NEMD
2019/2021 Colonoscopy Clear
2019/2020/2021 CT Scan Clear
2021 PET scan shows activity on liver
2021 MRI confirms one spot on liver

User avatar
Green Tea
Posts: 414
Joined: Mon Oct 24, 2016 10:48 am

Re: Recent HAI Pump?

Postby Green Tea » Fri Jun 11, 2021 4:41 am

Maybe part of the problem is that production of the Codman HAI pump was terminated by the manufacturer in 2018. Not enough demand. Not many pumps sold per year. Not very many hospitals using it. Not many doctors skilled enough to use it. Not profitable for the manufacturer to dedicate a production line to make such a product that brings in so little money:

https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=59743&p=474879#p474709

crikklekay
Posts: 129
Joined: Thu Feb 15, 2018 9:47 am
Location: Richmond, VA

Re: Recent HAI Pump?

Postby crikklekay » Sat Jun 12, 2021 11:24 am

Oh I had no idea they stopped production! That’s distressing, I’ve read of so many people here benefiting from it. Hopefully someone will come up with a similar technology, it seems like directing chemo straight at the problem would be better than running it through the whole body and hoping it sticks.

Tumor board surgeon said he won’t touch it (he’s the only surgeon locally who does liver oncology) and suggested just going straight to chemo. Oncologist says that’s idiotic without at least a biopsy and has referred John to an NCI hospital about an hour away. So more meetings, possibly more scans and a new tumor board to deal with =_=
Caring for DH John
Stage IIIC, Lymph nodes: 6/22
Chemotherapy: FOLFOX (6)
12/17 ER and emergency surgery
02/18 Hospital w/MSSA infected port, PICC line inserted, chest CT scan showed septic emboli & blood clots
03/18 Hospital w/CDIFF
04/18 Chest CT scan clear
06/18 Colonoscopy Clear
08/18 CT Scan Clear, NEMD
2019/2021 Colonoscopy Clear
2019/2020/2021 CT Scan Clear
2021 PET scan shows activity on liver
2021 MRI confirms one spot on liver

User avatar
ginabeewell
Posts: 500
Joined: Wed Oct 24, 2018 10:30 am

Re: Recent HAI Pump?

Postby ginabeewell » Sat Jun 12, 2021 3:15 pm

crikklekay wrote:Oh I had no idea they stopped production! That’s distressing, I’ve read of so many people here benefiting from it. Hopefully someone will come up with a similar technology, it seems like directing chemo straight at the problem would be better than running it through the whole body and hoping it sticks.

Tumor board surgeon said he won’t touch it (he’s the only surgeon locally who does liver oncology) and suggested just going straight to chemo. Oncologist says that’s idiotic without at least a biopsy and has referred John to an NCI hospital about an hour away. So more meetings, possibly more scans and a new tumor board to deal with =_=


Medtronic makes a pump that they use now instead of the Codman. It needs to be refilled a little more often but works the same way otherwise. That’s what I’ve used.

Northwestern told one of my nurses that they don’t do many because not many patients ask for it. Luckily they have been willing to follow MSK’s direction to use it for my treatment.
45 YO mom of twins (9) and lucky stepmom of 14/17 year olds
9/17/18 DX stage 4 CRC w inoperable liver mets CEA 931
10/18 FOLFOX + Vectibix
12/18 typhlitis (7 days in hospital) but largest met down to 5 cm.
12/18 CEA 4.6
1/18 Resume chemo (#6-8)
3/19 HAI pump placement / colon resection
4/19 Resume chemo (#9-19) FOLFOX (no OX) + Vectibix
5/19 CEA 1.3
7/19 liver resection
10/19 liver resection
1/20 NED! CEA 0.6
3/20 two new liver mets; FOLFIRI (5) and then add Vectibix (5)
8/20 CEA 0.7
Resection next?

mariane
Posts: 690
Joined: Sun Sep 13, 2015 6:16 pm

Re: Recent HAI Pump?

Postby mariane » Sat Jun 12, 2021 4:57 pm

Hi!
I am one of long timers on this forum. This spring I had surgery to remove the pump after 5 years of NED. I started with 10+ tumors, the largest was 7.5cm. Nobody gave me a chance to live 5 years. I am NED. I have my ups and downs. Chemo and pump are not easy for the liver. My bilirubin is between 1-2 most of the time. However, I eat and live normally and I am off all meds. I see my twins grow. They are 12 now.
I had Codman pump. Dr. Kemeny is still my oncologist. I see her only just once a year, now. Dr. D'Angelica was my brilliant surgeon.
Good luck!
mom of now 12 years old twins, dx @ 40 in 6/2015 with upper rectal cancer, 10+ liver mets, CEA 140
chemo: 8/2015 - 10/2016 - 4xFOLFIRINOX, 2xFOLFOX, 8xFOLFIRI, 10x5FU, HAI pump -12xFUDR
4 surgeries, complete pathological response
CEA<2 since 10/2015
NED since May 2016

I praise God for every day with my family!

Rock_Robster
Posts: 562
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Recent HAI Pump?

Postby Rock_Robster » Sat Jun 12, 2021 9:38 pm

It’s worth noting that HAI is now included in the NCCN treatment guidelines for CRC liver mets too, but only where delivered by a treatment centre with “with experience in this method” (basically MSK and a handful of others). So you could always refer your doctors to this, particularly if it’s an NCI designated centre.
39M Australia
10/2018 Dx RC, 12cm high
Mod diff, EMVI+ LVI+. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0, Mar-20=2.2, May-20=1.9, Jun-20=2.1, Sep-20: 2.1, Dec-20: 2.3, Mar-21=2.5
11/18 FOLFOX x6
3/19 Liver resection
5/19 25x pelvic radiation; complete met. response
07/19 ULAR w ileo, 1/27 LN+
08/19 Found liver spot
08/19 FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 Liver resection
02/20 Ileo reversed
03/20 NED (CT/PET/MRI/scope) - latest scans Mar ‘21


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