Cutting-edge chemo delivery for colorectal cancer
Patients with colon cancer that spread to the liver had few options if standard chemotherapy stopped working.
Now, a treatment that pumps chemo directly to the tumor is doubling the survival rate and giving patients precious time.
Rita LaFlamme has 57 years of memories and counting with her husband, Bob.
"We have two sons and two grandchildren," she said.
But both were stunned when LaFlamme was diagnosed with Stage 4 colorectal cancer last year.
Every year, nearly 140,000 people in the U.S. are diagnosed with colorectal cancer. In up to a quarter of those, it has spread to the liver.
When standard chemotherapy stops working, many patients are left with few options.
Now, doctors at Duke University are offering a treatment called hepatic artery infusion using a pump.
"The pump, which is a battery-powered motorized pump, is surgically implanted into a pocket in the abdominal wall," surgical oncologist Dr. Michael Lidsky explained.
The pump provides a direct dose of concentrated chemo to the liver.
"Those concentrations actually reach somewhere between three and 400 times the concentration that we would be able to get if we gave it intravenously," Lidsky said.
So far, the results have been dramatic. Lidsky says the treatment is used in combination with standard chemo and has been shown to double the survival rate.
"It's pumping on the tumor, and I'm not feeling a thing," LaFlamme said.
She says the treatment is working to shrink her tumor and she hopes to have surgery to remove it soon.
"I know I can beat this, I have no doubt in my mind that I will, I will beat it," LaFlamme said.
More time means more memories for her.
Lidsky says hepatic artery infusion is not a cure but can be used pre- or post-surgery to shrink tumors in patients with metastatic colorectal cancer to the liver.
Right now, the treatment is only being offered at a handful of centers around the country, including Duke and Memorial Sloan Kettering in New York.
The pump stays in the patient for years and can be used again if the disease recurs. Patients need to be fit and have liver-dominant disease only to be a good candidate.
TOPIC: CUTTING-EDGE CHEMO DELIVERY FOR COLORECTAL CANCER
REPORT: MB #4666
BACKGROUND: Most colorectal cancers start as a growth on the inner lining of the colon or rectum. These growths are called polyps. Some types of polyps can change into cancer over time (usually many years), but not all polyps become cancer. The chance of a polyp changing into cancer depends on the type of polyp it is. The two main types of polyps are Adenomatous polyps which sometimes change into cancer, and hyperplastic polyps or inflammatory polyps which are more common, but in general they are not pre-cancerous. If cancer forms in a polyp, it can grow into the wall of the colon or rectum over time. The wall of the colon and rectum is made up of many layers. Colorectal cancer starts in the innermost layer and can grow outward through some or all of the other layers. (Source: https://www.cancer.org/cancer/colon-rectal-cancer/about/what-is-colorectal-cancer.html)
TREATMENT: Chemotherapy may cause vomiting, nausea, diarrhea, neuropathy, or mouth sores. However, medications to prevent these side effects are available. Because of the way drugs are given, these side effects are less severe than they have been in the past for most patients. In addition, patients may be unusually tired, and there is an increased risk of infection. Neuropathy, which causes tingling or numbness in feet or hands, may also occur with some drugs. Significant hair loss is an uncommon side effect with many of the drugs used to treat colorectal cancer, except irinotecan. If side effects are particularly difficult, the dose of the drug may be lowered, or a treatment session may be postponed. (Source: https://www.cancer.net/cancer-types/colorectal-cancer/types-treatment)
NEW RESEARCH: Michael Lidsky, MD, a Surgical Oncologist at Duke University Medical Center said, "For people that have metastatic colorectal cancer, the best opportunity for long-term survival is to surgically remove all visible disease within the liver and combine that with chemotherapy. The estimated five-year survivals for patients that have surgery combined with chemotherapy are somewhere between 50 and 60 percent. But now that we have hepatic artery infusion, we can actually increase the likelihood of survival. And now we're seeing survival 10 years after surgery, which is just as good as what we previously saw at five years." (Source: Michael Lidsky, MD)