Medical oncologist Nancy Kemeny reviews evidence for HAI in extending survival and improving quality of life for patients with colorectal cancer and liver metastases.
Chemotherapy uses chemical substances to destroy cancer cells wherever they are in the body. This approach can significantly increase the length of life in people with liver metastases.
Given before surgery, chemotherapy can lower the risk of tumors coming back later on. Chemotherapy can also help shrink liver metastases from the colon and rectum so that they’re safer for a surgeon to take out.
Chemotherapy through Hepatic Arterial Infusion (HAI)
This procedure delivers drugs directly to the liver through an abdominal pump. This approach has given patients unprecedented curative and long-term survival potential for liver metastases that started in the colon or rectum.
The typical way to get chemotherapy is through an IV. This approach spreads the medicine throughout the body (systemic therapy). But if we only find cancer in your liver and nowhere else, we may have an option to give you chemotherapy with hepatic arterial infusion (HAI). This procedure delivers chemotherapy directly to where the tumor is located.
For HAI chemotherapy, we give a high dose of chemotherapy into the hepatic artery, which is the main source of blood and nutrients for liver tumors. We give the chemotherapy through a tiny pump that we implant under the skin in the lower abdomen. We can fill the pump with additional chemotherapy as needed over time.
The doctors at Memorial Sloan Kettering have a lot of experience with HAI chemotherapy. HAI chemotherapy helps some patients with liver metastases live longer after surgery. It may also lessen side effects and improve quality of life.
Some people with liver metastases can’t have surgery because of things like the number, size, or location of the tumors. For these individuals, systemic chemotherapy or HAI plus systemic chemotherapy may be an option because it may reduce the tumors enough that a surgeon can remove them.
Our researchers are constantly evaluating new chemotherapy combinations to improve the standard of care for people with liver metastases. These investigational therapies are sometimes offered to eligible patients through our clinical trials.
Chemotherapy drugs destroy some healthy cells in addition to cancer cells. Biologic drugs are more targeted. They can stop tumor cells from replicating and can disrupt the flow of blood to a tumor. Our treatment experts combine biologic drugs with chemotherapy to improve the effectiveness of treatment.
Your treatment team may recommend the following biologic drugs to treat liver metastases:
- anti-angiogenesis drugs stop the growth of blood vessels that nourish tumors. Our doctors can give anti-angiogenesis drugs with chemotherapy before or after surgery.
- epidermal growth factor receptor (EGFR) inhibitors block a protein that may contribute to the progression of colorectal cancer.
Before treating you with one of these drugs, your doctor will test you for a mutation in your KRAS gene. EGFR inhibitors aren’t effective when this mutation is present. Clinical trials are under way to evaluate drugs that may be effective in treating patients with a KRAS gene mutation.