What is hepatic arterial infusion?

The portal vein supplies two-thirds of the blood flow to the liver. The hepatic artery supplies the other third, but it’s the blood from this artery that feeds tumors in the liver.

With hepatic artery infusion, chemotherapy goes directly into the hepatic artery through a pump. The liver processes the chemo drug and very little reaches the rest of the body, reducing the side effects of this drug. Many patients will get HAI in combination with chemotherapy through a port that goes through the whole body. 

Hepatic arterial infusion can treat several types of cancer:

• Colon cancer that has spread to the liver (metastatic or stage IV colon cancer).
• Cancer that started in the bile duct of the liver and can’t be removed by surgery (unresectable intrahepatic cholangiocarcinoma or bile duct cancer).

The goals for treatment will depend on your overall health and the type and extent of the cancer. 

If you have metastatic colon cancer, the goal of HAI may be to prolong life or to potentially cure colon cancer that has spread to your liver. We use HAI to:

• Treat patients with liver tumors that can’t be removed by surgery.
• Shrink tumors in the liver and make it possible to perform surgery in the future.
• Prevent tumors from returning after they are completely removed with surgery.

In patients with bile duct cancer, we use HAI with the goal to extend life and, in some cases, shrink tumors enough for complete removal.

Markey treatment team

At Markey, our experienced multidisciplinary team includes:

• Surgical oncologists who implant the hepatic artery infusion pumps, manage issues with pumps or surgery, and work with colorectal surgeons who either remove the primary colon tumor (colon cancer only) or manage bowel blockages. 
• Medical oncologists who administer chemotherapy, monitor side effects, adjust dosages as needed and coordinate with the surgical oncology team to monitor the effects of therapy on the cancer.
• Pharmacists who carefully prepare chemotherapy drugs and assist the oncologist with drug dose adjustment.
• Experienced infusion nurses who safely access the pumps and monitor the patients for complications during treatment.
• Diagnostic radiologists who use imaging to ensure HAI pumps operate correctly and interventional radiologists who manage rare potential complications with blood vessels.
• Gastrointestinal doctors who address any GI complications.
• A research team investigating the latest potential treatments.

Frequently asked questions 

Q: Who’s a candidate for HAI?
A: We assess you to determine if it’s safe to give you hepatic arterial infusion. We consider these factors:

• The health of your liver and your overall wellbeing.
• How much chemotherapy you’ve had recently (to see if your body can handle the treatment).
• The anatomy of your liver and hepatic artery (pumps won’t work in some people).
• How far the cancer has spread beyond the colon or liver.

Q: What are the advantages of hepatic arterial infusion?
A: Because the drugs go directly into the liver, patients can get a higher dose of chemotherapy than possible with traditional chemotherapy. HAI can also help some patients live longer than they would with regular chemotherapy alone.

Q: How does hepatic arterial infusion work?
A: The pump delivers a continuous flow of chemotherapy into the liver every day. We use a needle to place the medication into the pump. HAI treatment typically lasts around five to six months.

We will refill the chemo medication about every 14 days. The refill is a simple process for patients, but the dosing for the chemotherapy drug is complicated and must be done at Markey. We are developing a clinical trial that will allow some community oncologists to administer pump chemotherapy, which is based on liver function and other factors.

Q: How do you implant the HAI pump?
A: The HAI pump is a device about the size of a biscuit or hockey puck. We typically implant it into the fatty tissue on the left side of your abdomen. A long internal tube goes from the pump into the hepatic artery. 

Implanting the device is a major operation with an incision that goes from the breastbone to near the belly button. You will need to stay in the hospital about five days after the procedure. Most patients don’t notice the device much once it’s put in place.

Q: What are the side effects of HAI?
A: You and your treatment team will weigh any possible side effects against the potential benefits of the treatment. Side effects may include:

• Pain
• Infection
• Bleeding
• Damage to the bile duct

Q: Is HAI a cure for cancer?
A: For many people, HAI can extend their life longer than standard chemotherapy. HAI is a possible cure for some people.