From the Guidelines
HAI pump therapy is a recommended treatment for advanced hepatocellular carcinoma, as it allows for high local concentrations of anti-cancer drugs in the tumor and reduces systemic adverse events, as shown in a recent study published in 2023 1.
Key Points
- HAI pump therapy is a locoregional treatment that uses a catheter technique to deliver anti-cancer drugs directly to the liver.
- The benefits of HAI pump therapy include increasing local concentrations of anti-cancer drugs in the tumor and reducing systemic adverse events due to anti-cancer drugs, as reported in a study published in Clinical and Molecular Hepatology 1.
- The treatment requires implantation of an indwelling catheter and port system, which allows for repeated intermittent administration of drugs.
- A recent review published in 2023 highlights the relevance of HAIC in the era of chemo-diversity, proposing a multidisciplinary therapeutic strategy combining locoregional HAIC treatment with sequential drug therapy 1.
Treatment Considerations
- Patients with unresectable hepatocellular carcinoma may benefit from HAI pump therapy, which can achieve response rates of 40-60% in previously treated patients and even higher rates in treatment-naïve patients.
- The treatment should be managed by specialized oncology teams at centers experienced with this therapy, with close monitoring for complications including chemical hepatitis, biliary sclerosis, gastritis, and pump-related issues.
- Regular maintenance of the pump with heparin/saline flushes every 4-6 weeks when not in use is necessary to prevent complications.
- The choice of chemotherapy regimen, such as cisplatin monotherapy or cisplatin plus 5-fluorouracil, should be individualized based on patient factors and tumor characteristics, as discussed in a recent study published in Clinical and Molecular Hepatology 1.
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 HAI Pump is recommended for the administration of floxuridine to ensure a uniform rate of infusion and to overcome pressure in large arteries.
- The use of a pump is advised for continuous arterial infusion of floxuridine 2
From the Research
HAI Pump Overview
- The Hepatic Arterial Infusion (HAI) pump is a treatment-delivery method used to target tumors directly, often in combination with systemic chemotherapy 3.
- The pump is used to deliver localized high-dose floxuridine directly to liver tumors through an implanted pump 4.
Complications and Management
- Common complications associated with the HAI pump include seroma, flipped HAI pump, infection, changes in pressure and temperature, challenging access, dry pump, high residual volume, chemical hepatitis, risk of ulcer, and radiologic imaging considerations 3.
- Nursing resources are crucial for safely administering medications and properly maintaining the function of the pump, with attention to patient education incorporated in nursing practice 3.
Treatment Efficacy
- Studies have shown that the HAI pump can produce high response rates and median survival in patients with unresectable hepatic metastases from colorectal carcinoma, with response rates ranging from 52% to 78% and median survival durations ranging from 13.5 to 24.8 months 5, 6.
- The addition of high-dose Mitomycin C to HAI FUDR and Dex has been shown to produce a high response rate, even in previously treated patients, with a median survival of 21 months 6.
Dosing and Management
- The dosing of floxuridine does not conform to the usual dose modification schema for systemic chemotherapy, and numerous clinical scenarios influence the dosing 4.
- Practical clinical management solutions are needed to overcome common challenges faced by oncologists in the real-world management of HAI pump therapy, including adjuvant therapy after liver resection with HAI FUDR/Dex plus systemic oxal and 5-FU 4, 7.