What is Hepatic Artery Infusion Pump (HAIP) for liver disease?

From the Guidelines

Hepatic Arterial Infusion Pump (HAIP) therapy should be considered for patients with unresectable liver metastases or as adjuvant therapy after liver resection, as it can significantly improve disease control in the liver compared to systemic chemotherapy alone, with a recommended regimen involving floxuridine (FUDR) at 0.12 mg/kg/day continuously for 14 days, followed by a 14-day rest period, as seen in studies such as 1. The approach allows for high concentrations of chemotherapy to reach the liver while minimizing systemic side effects, as the liver metabolizes most of the drug before it enters the general circulation. HAIP therapy is usually combined with systemic chemotherapy for optimal results. Some key points to consider when using HAIP therapy include:

• Patients require regular monitoring of liver function tests and pump functionality, with clinic visits every two weeks during initial treatment cycles.
• The pump reservoir needs refilling approximately every two weeks, and patients should be vigilant for signs of pump malfunction such as abdominal pain or swelling.
• HAIP therapy is particularly beneficial for patients with liver-predominant metastatic disease, as it can deliver up to 400 times higher drug concentration in liver tumors while reducing systemic toxicity, as noted in 1 and 1.
• The localized delivery mechanism of HAIP therapy makes it an effective option for selected patients, as seen in studies such as 1 and 1.
• However, it's essential to carefully evaluate the patient's overall condition, liver function, and performance status before initiating HAIP therapy, as recommended in 1.

From the FDA Drug Label

INDICATIONS AND USAGE: Floxuridine for Injection, USP is effective in the palliative management of gastrointestinal adenocarcinoma metastatic to the liver, when given by continuous regional intra-arterial infusion in carefully selected patients who are considered incurable by surgery or other means. DOSAGE AND ADMINISTRATION: ...The higher dosage ranges (0.4 to 0. 6 mg) are usually employed for hepatic artery infusion because the liver metabolizes the drug, thus reducing the potential for systemic toxicity.

The liver is a key organ in the metabolism of floxuridine, and hepatic artery infusion is a recommended method of administration for managing gastrointestinal adenocarcinoma metastatic to the liver 2. The dosage for hepatic artery infusion is typically higher (0.4 to 0.6 mg/kg/day) due to the liver's metabolizing effect, which reduces systemic toxicity 2.

From the Research

Liver HAIP Overview

• Liver HAIP (Hepatic Artery Infusion Pump) chemotherapy is a treatment approach for colorectal liver metastases, allowing direct infusion of chemotherapeutic agents into the liver 3, 4, 5.
• This approach is especially useful in the setting of multifocal liver metastases and can be combined with systemic chemotherapy to improve response rates and provide more durable disease control 3, 4.

Benefits and Potential Risks

• The benefits of HAIP chemotherapy include improved response rates, more durable disease control, and the potential for successful resection in some patients 3, 4.
• Potential risks and complications associated with HAIP chemotherapy include biliary sclerosis, catheter-related complications, and systemic toxic effects 5, 6, 7.
• Multidisciplinary collaboration between interventional radiologists, medical oncologists, hepatobiliary surgeons, and treatment nurses is necessary to ensure safety and effectiveness 3.

Treatment Outcomes

• Studies have reported encouraging response rates and conversion to resectability rates using HAIP chemotherapy in combination with systemic chemotherapy 4, 5, 6.
• Overall survival and progression-free survival rates have also been reported, with median overall survival ranging from 8.3 to 26.7 months and median progression-free survival ranging from 6 to 13 months 5, 6.
• Tumor response rates have been reported to be similar between surgical and percutaneous catheter placement methods, with response rates ranging from 26.5% to 48% 3, 7.

Comparison of Treatment Methods

• Studies have compared surgical versus percutaneous catheter placement methods for HAIP chemotherapy, with similar response rates and survival outcomes reported between the two methods 7.
• However, percutaneous catheter placement may be associated with increased bone marrow toxicity, mucositis, and diarrhea compared to surgical catheter placement 7.