What is the purpose of a Hepatic Artery Infusion (HAI) pump?

From the Guidelines

Hepatic artery infusion pump (HAIP) therapy should be considered for patients with unresectable liver metastases, particularly from colorectal cancer, as it has been shown to improve overall survival and response rates in selected patients 1. The use of HAIP involves the surgical implantation of a pump under the skin of the abdomen, which is connected to a catheter placed in the hepatic artery, allowing for continuous infusion of chemotherapy agents directly to the liver.

• Common medications used in HAIP therapy include floxuridine (FUDR) at doses of 0.1-0.2 mg/kg/day for 14-day cycles, alternating with 14-day rest periods.
• The effectiveness of HAIP therapy is due to the unique blood supply of liver tumors, which receive 95% of their blood from the hepatic artery rather than the portal vein, allowing for targeted drug delivery to cancer cells while sparing normal liver tissue.
• Patients with HAIP require regular monitoring of liver function tests and periodic pump refills every 2-4 weeks by trained healthcare professionals.
• Potential complications of HAIP therapy include pump pocket infections, catheter displacement, arterial thrombosis, and chemical hepatitis. The most recent and highest quality study on HAIP therapy was published in 2023, which demonstrated a superior overall survival (30.8 vs. 18.4 months, p <0.001) in patients with intrahepatic cholangiocarcinoma (iCCA) who received combined systemic chemotherapy and HAIP therapy compared to those who received systemic chemotherapy alone 1.
• This study also showed that HAIP therapy can be effective in downstaging initially unresectable iCCA, allowing for subsequent resection and improved overall survival.
• The use of HAIP therapy in combination with systemic chemotherapy has also been shown to improve response rates and overall survival in patients with unresectable iCCA. Overall, HAIP therapy is a valuable treatment option for patients with unresectable liver metastases, particularly from colorectal cancer, and should be considered in selected patients with careful monitoring and management of potential complications.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION: ...The administration of floxuridine is best achieved with the use of an appropriate pump to overcome pressure in large arteries and to ensure a uniform rate of infusion The hepatic artery infusion pump is recommended for use in administering floxuridine to ensure a uniform rate of infusion and to overcome pressure in large arteries, particularly for hepatic artery infusion.

• The use of a pump is necessary to achieve the desired therapeutic effect while minimizing potential systemic toxicity.
• The dosage range for hepatic artery infusion is 0.4 to 0.6 mg/kg/day 2

From the Research

Hepatic Artery Infusion Pump Overview

• The hepatic artery infusion (HAI) pump is a device used to deliver chemotherapy directly to the liver through the hepatic artery, allowing for higher concentrations of the drug to reach the tumor site 3, 4.
• This approach has been shown to improve survival rates and facilitate the conversion of unresectable disease to resectable disease in patients with colorectal liver metastases (CRLM) 3, 5.

Efficacy and Safety

• Studies have demonstrated that HAI pump chemotherapy can achieve response rates of up to 92% in patients with initially unresectable CRLM, with encouraging rates of conversion to resectability (CTR) 5.
• The safety and feasibility of HAI pump chemotherapy have been established in multiple centers, with manageable complication rates and local toxicities 6, 7.
• Common complications associated with HAI pump therapy include biliary sclerosis, catheter-related complications, and grade 3-4 toxicities such as neurotoxicity and neutropenia 3, 6, 7.

Clinical Applications

• HAI pump chemotherapy is a viable therapeutic option for patients with liver-only or liver-dominant disease who have progressed on first-line chemotherapy 4.
• The use of HAI pump chemotherapy in combination with systemic therapy has been shown to improve overall survival and progression-free survival rates in patients with CRLM 3, 5.
• HAI pump chemotherapy can also facilitate secondary resections in patients with initially unresectable disease, allowing for improved survival outcomes 7.