Hepatic Arterial Infusion Pump Therapy for Previously Treated Patients With Metastatic Colorectal Cancer

At Great Debates and Updates in Gastrointestinal Malignancies in New York, New York, Michael Liddsky, MD, Duke Health, Durham, North Carolina, discussed ways researchers are working to overcome barriers to hepatic arterial infusion pump therapy limitations for patients with unresectable, metastatic colorectal cancer. 

Transcript: 

Hi, I'm Mike Lidsky, I'm an associate professor of surgery at Duke Health and I'm here at Great Debates and updates in GI oncology. I'm debating the topic of hepatic arterial infusion [HAI] and whether it's worthwhile in patients with previously treated metastatic colorectal cancer to the liver. 

It's an interesting topic, it's a polarizing therapy. Some people feel very strongly that it is worthwhile and others feel very strongly that it is absolutely not, and so it's kind of a fun topic to talk about. It's not a new therapy.It's been around for over 50 years, but it hasn't really caught on until recently. Up until the last five years, it's really been performed at only a small number of centers, in particular Memorial Sloan Kettering, where most of the work, pioneering, and optimizing has taken place. 

Over the last few years there's been this renewed enthusiasm and it's spread across the country and really across the world in a way we haven't seen in years prior. The issue with the therapy is that it requires significant training, expertise, and infrastructure and when centers are interested in starting programs it's a pretty heavy lift. The main barrier to this therapy over the past couple decades have been the literature and the data supporting it. The trials are 15 to 20 years old, they use what are considered to be outdated regimens based on today's standards, and the rest of the literature is really made up of single institution studies or retrospective data, most of which is from Memorial Sun Kettering, so there's a lot of skeptics. in the community. We're working hard to fix that, we started a consortium for hepatic arterial infusion a few years ago and now in that group there are over 200 surgeons and medical oncologists from nearly 70 centers worldwide that get together regularly and our goal is to improve HA outcomes and really advance the field beyond where it currently stands.

I think what we'll show today in the talk is that HAI can be done effectively outside of the institutions that have pioneered it, but most importantly we really need modern day trials and we have that trial now. Cooperative groups, ECOG Acrin, and the NCCN have approved a trial to answer the age-old question of whether HAI is actually beneficial for patients with unresectable colorectal liver metastases. It's called EA2222 or the PUMP trial and it's a phase 3 study that's randomizing patients with liver-confined metastatic colorectal cancer who remain technically unresectable after 3 to 6 months of chemotherapy and patients will receive either standard of care chemotherapy alone or with the addition of hepatic arterial infusion. The primary endpoint of that study is overall survival and at the end of this trial I think we'll have the answer once and for all about whether HAI improves survival for this population.

Source: 

Lidsky M. Debate: Is hepatic arterial infusion pump (HAI) therapy worthwhile in previously treated mCRC patients? Yes vs no. Presented at Great Debates and Updates in Gastrointestinal Malignancies. May 17-18, 2024. New York, NY.