Hepatic artery infusion pump chemotherapy spares livers and saves lives

Nov. 03, 2022

2022 Intera Oncology. All rights reserved. Used with the permission of Intera Oncology.

A multidisciplinary team of surgery and oncology experts at Mayo Clinic Comprehensive Cancer Center has begun using hepatic artery infusion pump chemotherapy for select patients. The pump provides a liver-directed treatment option for patients who previously had none.

"Our goal is to expand the eligibility of patients who could be offered curative intent treatment," says Cornelius A. Thiels, D.O., M.B.A., a surgical oncologist at Mayo Clinic in Rochester, Minnesota. "In addition, we are aiming to reduce the risk of cancer recurrence in patients with high-risk liver tumors."

The liver-directed therapy involves surgically placing a pump directly into a branch of the hepatic artery. In some cases, the pump can be placed using robotic surgery. Chemotherapy is then delivered directly to the liver in a course of treatment that typically lasts six months, with visits to Mayo Clinic in Minnesota every two weeks.

Current indications and future directions

Currently, adult patients with one of three indications are eligible for hepatic artery infusion pump chemotherapy. The first, and most common, is patients with unresectable colorectal liver metastases. Patients may or may not still have their primary tumors in place. To be eligible for the hepatic artery infusion pump chemotherapy, patients must have minimal other disease outside of the liver and the primary tumor. Mayo Clinic experts recommend all patients with colorectal liver metastasis, regardless of disease burden, be evaluated at a high-volume liver center like Mayo Clinic.

The second indication currently being treated with this therapy is resectable colorectal liver metastases for patients who are at a very high risk of recurrence in the liver. These patients may have disappearing lesions, multiple lesions, recurrent metastases after previous resection or ablation, or progressive disease despite first or second line chemotherapy.

The third indication currently considered is unresectable intrahepatic cholangiocarcinoma. These patients' diseases cannot have metastasized outside of the liver.

Patients being evaluated for hepatic artery infusion pump chemotherapy will meet with Mayo Clinic's specialized team of both medical and surgical oncologists, including Dr. Thiels or one of his colleagues. Patients will be evaluated for disease state and overall health, as well as undergo specialized scans to determine eligibility for the pump.

Researchers at Mayo Clinic are studying not only the initial set of patients who have received chemotherapy in this way but also quality of life in these patients and additional indications that may benefit from the pump.

Targeted therapy and increased options

Hepatic artery infusion pump chemotherapy is often used when patients have exhausted all other treatment options. It is often used alongside other systemic therapies.

A primary advantage to treating liver metastases with the pump is the concentrated approach to applying chemotherapy. A stronger chemotherapy agent can be used, which means that when other therapies have failed to shrink a patient's tumor, therapy administered using the pump may bring about a better response.

"With the hepatic artery infusion pump, we can often achieve higher and more durable response rates than with conventional IV therapy," says Dr. Thiels. "Most importantly it opens up the potential for curative options for patients who did not have those options before."

The stronger chemotherapy is administered directly to the liver where it is metabolized, which eliminates any systemic side effects for the patient. While patients still may have side effects from surgery or other systemic therapies that are part of the treatment program, the chemotherapy administered by the pump typically does not add additional symptoms.

For more information

Refer a patient to Mayo Clinic.