Implementation and early outcomes for a surgeon‐directed hepatic arterial infusion pump program for colorectal liver metastases

Abstract

Introduction Hepatic arterial infusion pump (HAIP) therapy for colorectal liver metastases (CRLM) is beneficial in selected patients yet wide acceptance in the oncology community is lacking. Methods A surgeon‐led team implemented a HAIP program in 2012. Pumps were placed by laparotomy for CRLM and fluorodeoxyuridine was infused via HAIP every 28 days without systemic chemotherapy supervised by the operating surgeon. Results Sixty patients were treated with HAIP, either in the adjuvant setting after liver resection or ablation of CRLM in 26 (43%) patients or with the unresectable disease in 34 (57%). Perioperative complications occurred in 19 (32%) and pump‐specific complications in 14 (23%) that included intrahepatic biliary stricture in one (2%). Time to liver progression was a median 9.2 months (95% CI, 3.1‐15.3 months) in unresectable patients and liver recurrence was a median 24.7 months (2.5‐46.9 months) in the adjuvant group. Estimated 3‐year overall survival from the time of HAIP placement was 64% in the adjuvant group and 37% in the unresectable group. Sarcopenia was prevalent (48%) and was associated with a worse survival (HR 2.4, 95% CI, 1.1‐5.0). Conclusion A surgeon‐led HAIP program may achieve outcomes on par with those of experienced centers and foster strong relationships between surgical and medical oncologists.

Hepatic arterial infusion pump chemotherapy combined with systemic therapy for patients with advanced colorectal liver metastases: Outcomes in a newly established program

“…Our cohort of patients had advanced and high‐risk CRLM, with liver tumor volumes greater than 25% in half the patients and clinic risk scores ≥3 in all patients. Despite these poor prognostic markers, our results are similar to other groups across the country 16,17,21 . Further, higher tumor response rates have been reported in chemo‐naive patients treated with HAI and systemic chemotherapies; however, the patients in our study had been heavily treated with preoperative chemotherapy 16 .…”

“…Despite these poor prognostic markers, our results are similar to other groups across the country. 16,17,21 Further, higher tumor response rates have been reported in chemo-naive patients treated with HAI and systemic chemotherapies; however, the patients in our study had been heavily treated with preoperative chemotherapy. 16 patients frequently sought to incorporate cannabidiol and other marijuana products into their prescribed or self-administered therapy regimens.…”

“…14 With mounting evidence supporting HAI therapy for CRLM and primary liver cancers, 20 there is increased interest in developing HAI pump programs at other cancer centers across the country. While the bulk of published literature from the modern era of HAI pump therapy stems from MSK, there have been an increasing number of reports from newly established HAI pump programs 21,22 ; however, these reports have been confined to the eastern United States. Herein, we aim to describe the initial experiences and patient outcomes from our multi-disciplinary HAI program established in 2016 at a National Cancer Institute-designated Comprehensive Cancer Center.…”

Adjuvant Hepatic Arterial Infusion Pump Chemotherapy After Resection of Colorectal Liver Metastases: Results of a Safety and Feasibility Study in The Netherlands

“…Previous studies demonstrated both safety and feasibility concerns due to its complexity, requiring both technical knowledge and practical skills 7 – 9. However, a previous study of 544 patients demonstrated that an experienced team was associated with less pump-related complications.…”

Adjuvant hepatic arterial infusion pump chemotherapy after resection of colorectal liver metastases; results of a safety and feasibility study in the Netherlands

“…Previous studies demonstrated both safety and feasibility concerns due to its complexity, requiring both technical knowledge and practical skills. [7][8][9] However, a previous study of 544 patients demonstrated that an experienced team was associated with less pump-related complications. The pump failure rate was only 5% in the first 6 months after implantation.…”