Michael Lidsky, MD, and Justin Barr, MD, work to implant an HAI pump into a patient's abdominal wall.
A chemotherapy infusion pump is giving more time to people whose metastatic colorectal cancer has spread to the liver and who may have been told they are out of options. Duke Health surgical oncologists were the first to implant the hepatic artery infusion (HAI) pump following its FDA approval. They are among the few U.S. surgeons with the training and expertise to offer this highly specialized treatment.
“Most people are looking to live as long as possible with the best quality of life,” said Michael Lidsky, MD, a Duke Health surgical oncologist who performs the procedure. “Hepatic artery infusion can give them that. And, now that the pump is approved for use by the FDA, we hope more people will get access to it and the benefits it provides.”
The Role of Hepatic Artery Infusion
When colorectal cancer spreads, it frequently results in metastatic tumors in the liver. When possible, the liver tumors are surgically removed, and chemotherapy destroys the remaining cancer cells. Sometimes the tumors can’t be removed because of their location or size, or the available treatments simply can’t slow the disease. At this point, some people are told by their doctors that chemotherapy is their only option. Or worse, that nothing more can be done.
However, there is another option. It just hasn’t been widely available because it requires specialized training in surgical and medical oncology.
Hepatic arterial infusion delivers chemotherapy through a pump that’s implanted in the abdominal wall. “We then use a catheter to deliver high doses of chemotherapy through the hepatic artery, which directly feeds metastatic tumors in the liver,” said Peter Allen, MD, a Duke surgical oncologist. Even though the HAI pump delivers chemotherapy directly to the liver at concentrations that are hundreds of times higher than whole-body chemotherapy, it does not increase the side effects beyond those associated with whole-body chemotherapy.
If the liver tumors can be removed -- doctors use the term “resected” -- the pump may be implanted at the time of surgery and used to delay or prevent recurrence of cancer. If the liver tumors cannot be removed, the pump may be inserted to help control the tumor or, even better, shrink its size so it can be surgically removed in the future.
Duke Surgeons’ Expertise with HAI Pumps
Drs. Lidsky and Allen and their Duke colleagues have implanted more than 60 pumps in people with liver metastases from colorectal cancer since they started offering the procedure in conjunction with whole-body chemotherapy in late 2018. In many cases, they also work alongside Duke surgical oncologist Sabino Zani, MD, who uses minimally invasive techniques, including robotic surgical approaches to implant the pump. The minimally invasive approach, which requires smaller incisions than traditional surgery, allows people to spend less time in the hospital, and recover faster.
Improving Patient Access and Outcomes
While hepatic arterial infusion has only been available at a handful of centers, Dr. Lidsky hopes that will change as a result of the FDA approval. He co-leads a consortium of programs from around the world to perform studies that further demonstrate the HAI pump’s effectiveness and to better identify the right candidates for the procedure. “The goals of the consortium are to further improve HAI outcomes, help launch new HAI centers, and make the pump more widely available to patients,” he said.
Promising Results in Metastatic Liver Cancer
The early results are promising. So far, the Duke team has been successful in converting tumors from ones that couldn’t be surgically removed to tumors that could be removed, they’ve given more time to people who were told they only had less than a year to live, and they have been able to prevent or delay the recurrence of liver cancer.