27: Initial Outcomes of a Single-Institution Hepatic Artery Infusion Pump Program for Colorectal Liver Metastases and Intrahepatic Cholangiocarcinoma

Saturday, February 17, 2024

7:50 AM - 8:00 AM AST

Location: Miramar I & II

Abstract Presenter(s)

Henry J. Stitzel, BS

Medical Student
Case Western Reserve University School of Medicine
Peninsula, Ohio, United States

Submitter(s)

Henry J. Stitzel, BS

Medical Student
Case Western Reserve University School of Medicine
Peninsula, Ohio, United States

Author(s)

Henry J. Stitzel, BS

Medical Student
Case Western Reserve University School of Medicine
Peninsula, Ohio, United States
MC

Michelle Chung, MD

Resident
University Hospitals, United States
ST

Sree Harsha Tirumani, MD

Physician
Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
DB

David Bajor, MD

Assistant Professor
3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
SC

Sakti Chakrabarti, MD

Assistant Professor
3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
ML

Melissa Lumish, MD

Assistant Professor
3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
MC

Madison Conces, MD

Assistant Professor
3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
AM

Amit Mahipal, MD

Assistant Professor
3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
LH

Lauren Henke, MD

Assistant Professor
3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
JA

John B. Ammori, MD

Associate Professor
4. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
JH

Jeffrey M. Hardacre, MD

Professor
4. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
JW

Jordan M. Winter, MD, MBA

Professor
4. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
JS

Jennifer Selfridge, MD, PhD

Assistant Professor
3. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
LO

Lee M. Ocuin, MD

Associate Professor
4. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States

Disclosure(s):

Henry J. Stitzel, BS: No financial relationships to disclose

Lee M. Ocuin, MD: No financial relationships to disclose

Introduction:

Hepatic artery infusion (HAI) therapy with floxuridine (FUDR) is a treatment option for both colorectal liver metastases (CRLM) and unresectable intrahepatic cholangiocarcinoma (ICC) that is being increasingly utilized. We describe postoperative and early oncologic outcomes following activation of a new single-institution HAI program.

Methods:

All patients who underwent HAI pump placement from April 2022 through August 2023 were included. Data were collected by retrospective chart review. Feasibility was defined as receiving at least 1 cycle of FUDR. Technical success was defined as post-operative nuclear medicine study showing no extrahepatic perfusion and bilobar hepatic perfusion. Radiographic response was assessed by a radiologist using RECIST 1.1 criteria. Disease control (DC) was defined as partial response (PR) or stable disease (SD).

Results:

A total of 23 patients underwent HAI pump placement by one surgeon (LMO), co-managed by one medical oncologist (JES). Nineteen had CRLM and 4 had unresectable ICC. Most (96%; 22/23) received systemic chemotherapy (median: 6 cycles) prior to pump placement. Seventeen concomitant procedures were performed in 11 patients with CRLM (colectomy [n=8], proctectomy [n=2], partial hepatectomy [n=4], microwave ablation [n=3]). Five patients (22%) experienced Clavien-Dindo Grade >3 complications within 90d of pump placement. Six patients (26%) experienced HAI pump-specific complications (pump pocket [n=4], hemorrhage [n=1], biliary sclerosis [n=1]). There were no 30d mortalities and 1 patient experienced rapid tumor progression and died within 90d. Feasibility was 96% (22/23). Technical success was 100%. Median time from surgery to initiation of HAI was 14d. Median number of FUDR cycles received was 5. Ten patients (45%) experienced a dose reduction and 17 (77%) experienced a dose hold. Eighteen patients (82%) had measurable disease on pre- and post-HAI pump implantation. At the time of data analysis, median follow-up time from pump placement was 7 mos and DC was 89%. Nine patients (50%) had PR and 7 (39%) had SD. Two patients (11%) had progression. Two patients with CRLM underwent complete metastasectomy within 12 mos of pump implantation.

Conclusions:

HAI therapy for CRLM and cholangiocarcinoma is associated with promising oncologic outcomes including disease control and downstaging to resectability. Implementation of a new HAI program is safe and feasible, and our early outcomes appear comparable to those seen at more experienced centers.

Learning Objectives:

Describe that HAI pump placement for colorectal liver metastasis or intrahepatic cholangiocarcinoma has a high technical success rate (100%) and high feasbility (96%).
Recognize that HAI therapy has an associated pump-specific complication rate of 26%.
Appreciate that most HAI therapy patients (89%) have disease control at a median of 7 months post-pump placement.