Experienced Team
At Fred Hutch and UW Medicine, we have an expert multidisciplinary team that provides HAI therapy. Many of our patients have received all their cancer care through Fred Hutch. We also offer HAI therapy to people from across the state, the region and beyond who began their cancer care somewhere else. Our team gives second opinions as well.
When colon cancer spreads to the liver from another part of the body, doctors have many ways to treat it. Hepatic artery infusion (HAI) therapy is a focused option that delivers high-dose chemotherapy directly to liver tumors. It relies on a small pump under the skin that sends medicine to these tumors 24/7 for two weeks at a time.
Fred Hutch Cancer Center is the only place in Washington state, and one of only a handful on the West Coast, to offer HAI therapy. This approach may be able to shrink liver tumors enabling surgeons to remove them, prevent tumors from coming back and help you live longer with the best quality of life.
What is HAI therapy?
HAI therapy is a method to get strong chemotherapy to liver tumors with little to no effect on other parts of the body. It uses a pump slightly smaller than a hockey puck to inject medicine into the main artery to the liver (hepatic artery).
Liver tumors get their blood supply from this artery. The rest of the liver gets most of its blood from a different vessel, the portal vein. This means medicine put into the hepatic artery goes quickly to your liver tumors, and very little reaches your healthy liver cells.
Systemic chemotherapy, the type given through an intravenous (IV) line, travels throughout your body. So, it can affect a wide range of tissues. This accounts for the range of common chemotherapy side effects, such as hair loss. Because the chemotherapy can affect so many tissues, physicians have to limit the dose.
HAI therapy is different. It’s focused. Your liver processes the medicine so thoroughly that the rest of your body is largely spared. As a result, you can receive a much higher, more effective dose of medicine — 300 to 400 times higher than in systemic chemotherapy — but with fewer side effects.
To receive HAI therapy, it’s important to have a team of experienced providers. At Fred Hutch, our experts work together closely to plan and provide your care. Your team will include a surgical oncologist, medical oncologist, radiation oncologist, nuclear medicine physician, radiologist, infusion nurse and others based on your needs.
Who needs HAI therapy?
HAI therapy may be an option if you have cancer that started in the colon or rectum and then spread to the liver (metastatic colorectal cancer). Researchers are also studying this therapy for use against other cancers, such as neuroendocrine tumors and some bile duct cancers (intrahepatic cholangiocarcinoma).
HAI therapy can be used:
- After liver surgery to kill microscopic cancer cells that might remain in the liver and lower the chance that cancer will come back in the liver. In this case, you might have an HAI pump placed while you are still under anesthesia for the liver surgery to remove your tumors.
- Instead of surgery to shrink or control liver tumors that surgeons cannot remove (usually because of where they are or how large or widespread they are). Sometimes HAI therapy can shrink tumors enough that surgery becomes possible.
- If other treatments aren’t controlling your cancer but the disease is only in your liver. If cancer has spread more widely in your body, HAI therapy may not be the best treatment for you.
- Along with systemic chemotherapy to treat cancer elsewhere in the body. Most people who get HAI therapy still get systemic chemotherapy.
First Appointment
Your first HAI therapy appointment is a time for you and the HAI therapy team to meet.
- If you are already receiving care at Fred Hutch, your medical oncologist will likely be the first member of your care team to talk with you about HAI therapy. Then you’ll meet with a surgical oncologist to learn more about this treatment option.
- If you are getting your cancer care somewhere else and were referred to Fred Hutch for HAI therapy, your first appointment here will be with a surgical oncologist.
You and your physician will talk about your health and how HAI therapy may fit into your treatment plan.
Your appointments are also a time for us to get to know you as a person. This helps us personalize our recommendations to you. Together, you and your care team will decide what needs to happen next.
We encourage everyone to bring a family member or friend to their first appointment and any future visits.
What to Expect
First appointments usually last up to one hour. Here is what you can expect to happen.
Discussing HAI Therapy
HAI therapy means having surgery to implant a pump in your abdomen, and then having the pump refilled every two weeks at an office visit. Each treatment cycle is 28 days. For the first two weeks of the cycle, your pump will be filled with chemotherapy. For the second two weeks, it will be filled with saline. Then the cycle will repeat.
Your team will talk with you about:
- What the surgery involves
- How we expect it will go for you and what the results may be like
- How HAI therapy fits in with any other treatment options you have
- What it will be like to get chemotherapy refills for your pump
- How our team supports you throughout the process
- Other ways we can help with your health and well-being
Getting to Know You
Your appointments are also a time for you to tell us about yourself. Each patient and family have their own needs, values and preferences. We want to get to know you so we understand the best way to care for you. For example, it is helpful for us to know:
- How much detail you would like about your disease, the treatments and the long-term outlook
- What your goals are for treatment and what matters most to you about the process of getting care
- Who will support and take care of you when you need help
- What concerns you have about how treatment could affect your work or home life
Answering Your Questions
We are always here to answer your questions. We want to help you understand as much as you want to know about your disease, your treatment and how care happens at Fred Hutch and UW Medical Center – Montlake.
To get you started, here are some questions you might want to ask:
- What are the benefits and risks of HAI therapy?
- How soon would I need to have this treatment?
- What do you expect my recovery will be like after surgery to implant the pump?
- What other treatments will I need before or after surgery?
We strongly encourage you to bring a friend or family member with you to help keep track of your questions and the information that your team gives you.
Deciding What is Next
Before you leave, we will make sure you know what is going to happen next and how you can reach us if you have questions later. We will schedule your future visits or make sure you know when and how to schedule them.
If you are from outside the Seattle area and getting other parts of your care at a center closer to home, we will communicate with your local team, too. We will make sure they understand our recommendations so we can work together to provide the care you need.
If you would like more time to think before deciding about treatment, we understand. Ask your team to explain how soon you need to decide.
Treatment Process
If you and your care team decide that HAI therapy is a good option for you, we’ll work with you to schedule surgery to implant your pump. Once the pump is in place, you’ll visit the clinic every two weeks to get the pump refilled.
Surgery to place a hepatic artery pump
To begin HAI therapy, a surgeon will place the pump under the skin on your belly, usually on the left side. Then they’ll run a small, flexible tube (catheter) from the pump to a blood vessel that leads into the hepatic artery. Our HAI surgical team does this at UW Medical Center – Montlake.
We most commonly place HAI pumps through a few small incisions using a robotic surgery system (minimally invasive robot-assisted surgery). For many patients, minimally invasive surgery results in less pain and scarring, a shorter hospital stay and faster recovery than with open surgery. We’ll talk with you about the method we recommend in your situation and why.
After surgery, your skin will completely cover the pump. You might be able to see or feel a slight bulge where the pump is, but otherwise, most people get used to it. A physician or nurse will use a syringe to fill the pump with medicine.
To make sure the medicine is traveling through the right blood vessels, you’ll have an imaging test, called nuclear medicine scan. This allows your team to confirm that the medicine is going only to your liver.
Most people need to stay in the hospital for one night to recover from surgery. If you had tumors removed during the same operation, you will probably need more time to recover before going home. Your care team will explain what to expect in your case.
Office visits to refill your hepatic artery pump
Every two weeks, you’ll come to the Fred Hutch South Lake Union Clinic Building 2 for an office visit to refill your pump. At these visits, you’ll see a medical oncologist who is experienced with HAI therapy. A nurse with HAI training will drain the pump and then refill it using a syringe . The process takes only about 10 to 15 minutes.
At office visits , you’ll have blood drawn for liver function tests. The results help us check how your healthy liver cells are working. We’ll carefully monitor you for any side effects and adjust your treatment if needed. You will likely also get systemic chemotherapy, typically through a port (central venous catheter), at these visits.
The pump can stay in place for months to years. It depends on your needs. Even if you stop HAI therapy at some point, your care team may suggest keeping the pump for a while in case you need to use it again. When you’re ready, a surgeon will take the pump out. This is an outpatient procedure. You can go home the same day.