Sunnybrook's Dr. Paul Karanicolas and Dr. Yoo-Joung Ko are about to launch a pioneering pilot program for a chemotherapy delivery device for patients with colorectal cancer that has spread to multiple sites in the liver.
The treatment, hepatic arterial infusion pump (HAIP), involves implanting a small, hockey-puck shaped pump device. A catheter is inserted into the main artery to the liver, the hepatic artery, to target 400 times the usual dose of chemotherapy to cancer sites while sparing the rest of the body from that concentration. Regular intravenous (IV) chemotherapy is given in conjunction with HAIP After reducing the number and size of liver cancer sites from many to a few, those that remain may then be able to be removed surgically.
Colorectal cancer is the third most common cause of cancer death in Canada. For about half of patients, the cancer metastasizes to the liver.
In the past, multiple liver cancer tumours meant that there was little doctors could offer except limited chemotherapy and palliative care, as the amount of chemotherapy required to reduce the cancer would cause too many serious side effects. Even with modern chemotherapy, a second IV treatment offers a 25 per cent chance of response for patients where first-line treatment is no longer working.
Remarkably, the odds of a successful response with HAIP plus IV chemotherapy are three times greater, about 75 per cent. "There have been several patients where standard chemotherapy was not working and who really had few other options. A pump was put in and they had a dramatic response, from having 50 tumours to having only two or three that could then be removed surgically. Many patients can live for several years and some patients have been cured after HAIP combined with IV chemotherapy and surgery," says surgical oncologist Dr. Karanicolas.
Before coming to Sunnybrook, Dr. Karanicolas did his surgical training at Memorial Sloan-Kettering Cancer Center in the U.S., where he gained experience in the technique. He and Dr. Ko are part of Sunnybrook's team of five multidisciplinary specialists working on the new HAIP program; their primary focus is to find the best cancer treatment for each patient.
"We focus on the HAIP pump but when patients come to us, they're coming with a problem, colorectal cancer that's spread to the liver. Our whole team sees them and we have a case conference to determine the best individual treatment plan. It really is personalized medicine at the highest level," says Dr. Karanicolas.
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