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Is Hepatic Arterial Infusion Or BRAF Chemotherapy Method Advisable For Treating Liver Cancer?
Question: Hi Doctor Rommstein,
My options are down to two.A BRAF chemotheraphy trial that several hospitals are running.The second is the heptic alterial infusion pump which to me is much preferred.Also the Clevland Clinic will be looking at my cat scan tomorrow to determine if there is a possibility of a second liver resectiopn XXXXXXX XXXXXXX surgeon says he does not think there would be enough liver left.I have found 1 cm lesions and three sub cm lesions.These occured withon 70 days afterr surgery.The doctor at the Clevland clinic today told me he does not understand why the University of XXXXXXX is recommending the test instead iof the infusion pump.He said conventional chemotheraphy,Folfox,Folfiri and Avastin led me to the resection therefore he thinks the infusion pump should be a viable option.The doctor at the university of XXXXXXX the day I met him suggested the pump but the following day said his tumor board overwhelmingly said I should be in the test.The surgeon at XXXXXXX XXXXXXX at first said both would be fine but it was my decision.When pressed he said the pump would be his recommendation.Is there any reason in your mind why I should take the BRAF clinical chemotheraphy test and not the alterial infusion pump?
Thank you,
My options are down to two.A BRAF chemotheraphy trial that several hospitals are running.The second is the heptic alterial infusion pump which to me is much preferred.Also the Clevland Clinic will be looking at my cat scan tomorrow to determine if there is a possibility of a second liver resectiopn XXXXXXX XXXXXXX surgeon says he does not think there would be enough liver left.I have found 1 cm lesions and three sub cm lesions.These occured withon 70 days afterr surgery.The doctor at the Clevland clinic today told me he does not understand why the University of XXXXXXX is recommending the test instead iof the infusion pump.He said conventional chemotheraphy,Folfox,Folfiri and Avastin led me to the resection therefore he thinks the infusion pump should be a viable option.The doctor at the university of XXXXXXX the day I met him suggested the pump but the following day said his tumor board overwhelmingly said I should be in the test.The surgeon at XXXXXXX XXXXXXX at first said both would be fine but it was my decision.When pressed he said the pump would be his recommendation.Is there any reason in your mind why I should take the BRAF clinical chemotheraphy test and not the alterial infusion pump?
Thank you,
Brief Answer:
hi again
Detailed Answer:
Hi.
I said that I would choose intraarterial pump in your case, but trial is also justified option. I dont have some strong evidence to prefer the pump, but this is my opinion. However, trials are good since newest chemotherapeutics are used and there are examples where very good responses were seen. The thing is, that we cant predict the response on these two treatment approaches since each patients responds differently. So this is a reason why oncologists may recommend different approaches. There is no enough scientific data that could support any of these choices. Since you already had first line chemotherapy and resection and then recurrence again, there is probably additional tumor mutation so BRAF targeted may be efficient, I cant say anything against this. But if there is tumor resistancy then the whole therapy may be useless and you may lose precious time. In intraarterial pump, even if there is resistency, intraarterial-chemotherapy may still slow down tumor progression, although it cant cure it. On the other hand, if trial is completely successful,there is, although very small, possibility for long term survival.
We simply cant give an answer which would be 100% right. So it is really up to you at the end. Honestly, some magic recovery on both these options should not be expected,but whatever you choose, it isnt wrong and you cant know the efficiency of the therapy until it is started.
hi again
Detailed Answer:
Hi.
I said that I would choose intraarterial pump in your case, but trial is also justified option. I dont have some strong evidence to prefer the pump, but this is my opinion. However, trials are good since newest chemotherapeutics are used and there are examples where very good responses were seen. The thing is, that we cant predict the response on these two treatment approaches since each patients responds differently. So this is a reason why oncologists may recommend different approaches. There is no enough scientific data that could support any of these choices. Since you already had first line chemotherapy and resection and then recurrence again, there is probably additional tumor mutation so BRAF targeted may be efficient, I cant say anything against this. But if there is tumor resistancy then the whole therapy may be useless and you may lose precious time. In intraarterial pump, even if there is resistency, intraarterial-chemotherapy may still slow down tumor progression, although it cant cure it. On the other hand, if trial is completely successful,there is, although very small, possibility for long term survival.
We simply cant give an answer which would be 100% right. So it is really up to you at the end. Honestly, some magic recovery on both these options should not be expected,but whatever you choose, it isnt wrong and you cant know the efficiency of the therapy until it is started.
Above answer was peer-reviewed by :
Dr. Prasad
HI Doctor,
There is a surgeon at the XXXXXXX Clinic,one of the best cancer clinics in the U.S, who will be reviewing my cat scan tomorrow to see if there is a possibility of a second resection.He also has experience in the hepatic arterial infusion pump.I have two oncologists that push me in the direction of the BRAF trial and against the infusion pump but will not tell me why.
Infusion pumps are at least 20 years old.I have asked the manufacturer of a list of every hospital who they sell their pumps to.It is hard for me to believe that the many 1000's of pumps that have been implanted that many were not for patients with the BRAF gene.There must be a history.
I currently have seven new lesions four 1 cm 3 sub centimeters.Is there a reason if I can kill these tumors I can not have a second resection? I had 18 treatments of chemotherapy and will do everything humanly possible to not go through that again.I also have an appointment with a radiologist on Thursday.There are many procedures that are available to deal with liver tumors.
Thank you for your encouragement.
XXXXXXX
There is a surgeon at the XXXXXXX Clinic,one of the best cancer clinics in the U.S, who will be reviewing my cat scan tomorrow to see if there is a possibility of a second resection.He also has experience in the hepatic arterial infusion pump.I have two oncologists that push me in the direction of the BRAF trial and against the infusion pump but will not tell me why.
Infusion pumps are at least 20 years old.I have asked the manufacturer of a list of every hospital who they sell their pumps to.It is hard for me to believe that the many 1000's of pumps that have been implanted that many were not for patients with the BRAF gene.There must be a history.
I currently have seven new lesions four 1 cm 3 sub centimeters.Is there a reason if I can kill these tumors I can not have a second resection? I had 18 treatments of chemotherapy and will do everything humanly possible to not go through that again.I also have an appointment with a radiologist on Thursday.There are many procedures that are available to deal with liver tumors.
Thank you for your encouragement.
XXXXXXX
Brief Answer:
hi
Detailed Answer:
Yes, you are well informed about all these issues.
There are many procedures, surgical, radiological, also RFA, TACE, etanol injections and other methods are described. The fact is, that this is serious disease and tumor has spread. Only liver resection can be curable and it is not an option at this point and I am afraid that it will never be. Other methods are palliative, however, it doesnt mean that it cant enable long term survival. By "long-term" iI mean 3 or more years.
This is unfortunately diffusely spread tumor in liver and methods that kill single tumor lesions such as resection, RFA or TACE are not efficient in these cases. Only methods that deliver chemotherapeutics diffusely into liver can be considered.
Intraarterial pump does it, and chemotherapy does it. If you want to avoid chemotherapy side effect then I am afraid that pump will also have similar side effects,probably in less degree but this is unavoidable.
In best scenario, chemoth or pump may lead to tumor "downstaging" which could allow liver resection in future which would be great. Chances for this are very small but not impossible.
I still cant give clear decision about the right option since I would need more documentation. But between these two option there is no wrong one, it is just important to start with the treatment as soon as possible.
Warm regards
hi
Detailed Answer:
Yes, you are well informed about all these issues.
There are many procedures, surgical, radiological, also RFA, TACE, etanol injections and other methods are described. The fact is, that this is serious disease and tumor has spread. Only liver resection can be curable and it is not an option at this point and I am afraid that it will never be. Other methods are palliative, however, it doesnt mean that it cant enable long term survival. By "long-term" iI mean 3 or more years.
This is unfortunately diffusely spread tumor in liver and methods that kill single tumor lesions such as resection, RFA or TACE are not efficient in these cases. Only methods that deliver chemotherapeutics diffusely into liver can be considered.
Intraarterial pump does it, and chemotherapy does it. If you want to avoid chemotherapy side effect then I am afraid that pump will also have similar side effects,probably in less degree but this is unavoidable.
In best scenario, chemoth or pump may lead to tumor "downstaging" which could allow liver resection in future which would be great. Chances for this are very small but not impossible.
I still cant give clear decision about the right option since I would need more documentation. But between these two option there is no wrong one, it is just important to start with the treatment as soon as possible.
Warm regards
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Hi Doctor,
Thank you for your advise.I have some of the best doctors however I get conflicting advise which is very confusing.In retrospect the surgeon at XXXXXXX XXXXXXX after meeting with his tumor board should not have recommended surgery because I have the BRAF gene.Then after surgery he and my oncologists in XXXXXXX never spoke so I was told by my oncologists to come back in 90 days for a cat scan.My doctorat XXXXXXX XXXXXXX thought I needed chemo maintenance but when I told him what my XXXXXXX doctor said he said that was fine.If the doctors spoke to each other I probably would have been back on some type of chemotherapy six weeks after my surgery.My last treatment was April 1st.
I then called the XXXXXXX Clinic one of the best hospitals in the U.S. I was shocked a surgeon called me and gave me his cell phone number.He is world famous.He wants me to come next week for a cat scan and a pet scan.He was shocked I had never had a pet scan.He said after reading my cat scan his initial response was a partial resection for the 1cm tumors and ablation for the sub centimeters and then an infusion pump.
Yesterday I met a local interventional radiologist.He said do not have surgery as you will lose too much of your liver and some disease will probably come back.He knew about the infusion pump but was a little concerned as he had heard it causes liver damage from toxicity.He talked about several options and I have a follow up appointment with him on September 6th.He said someone needed to take control of my case and handle my care.He said he would do that.
XXXXXXX Kettering invented the infusion pump and every article I read says it prolongs your live over standard chemotherapy.If you put into your browser hepatic arterial infusion pump you will see many studies to support longer life over standard chemotherapy.I had an appointment at XXXXXXX Kettering but cancelled it as I need to process all of the information and advise I have been given by many doctors.
The radiologist talked about killing the existing tumors with hot or cold needles.He also said I could come in once a month and have chemo directed into my liver.He suggested systemic chemotherapy I think because he may think the cancer may spread.Thus far it has been confined to my liver.
My goal is simple.I can not withstand the standard chemo I received for 18 treatment.It served it purpose but my quality of life was terrible.For 10 months it was either in bed or the couch.I was afraid to eat as my bowel movements were too painful.I had no appetite.So I want to kill the cancer I have in my liver if possible and have some type of treatment but not systemic chemotherapy.
As I mentioned XXXXXXX Kettering invented the pump and my doctor at the XXXXXXX clinic has used it before however my local oncologist,the oncologist at the University of XXXXXXX do not like it.Both want me to enter a BRAF trial of Chemotherapy.I do not want this.
To confuse matters even more this is what I received from MD XXXXXXX yesterday
Hi Mr. XXXX,
Most studies looking at the use of hepatic arterial infusions for the treatment of metastatic colon cancer in the liver have not demonstrated an improvement in survival compared to chemotherapy alone. It's currently not a standard of care treatment, but it is used in select centers for select patients. It is not our practice to use this treatment due to lack of survival benefit and increased risk for liver damage.
I think the excerpt above from our website is referring to treatment options for hepatocellular carcinoma, or primary liver cancer, as opposed to cancer that started in the colon and has now spread into the liver. For example, we also do not use the drug sorafenib for treatment of metastatic colon cancer; that drug is only approved for the treatment of hepatocellular carcinoma and renal cell carcinoma (kidney cancer).
I spoke with Dr. Dasari again about your case, and he is happy to give you a formal opinion on your best treatment options if you can come for a visit here. I know this is less than convenient, but we are unable to give opinions over the phone or by e-mail without seeing you again.
I hope this information helps.
XXXXXXX
So I will go to the XXXXXXX Clinic and see what they have to say and then the radiologist who will talk to my two local oncologists.
THank you for all of your kind advise
XXXXXXX
Thank you for your advise.I have some of the best doctors however I get conflicting advise which is very confusing.In retrospect the surgeon at XXXXXXX XXXXXXX after meeting with his tumor board should not have recommended surgery because I have the BRAF gene.Then after surgery he and my oncologists in XXXXXXX never spoke so I was told by my oncologists to come back in 90 days for a cat scan.My doctorat XXXXXXX XXXXXXX thought I needed chemo maintenance but when I told him what my XXXXXXX doctor said he said that was fine.If the doctors spoke to each other I probably would have been back on some type of chemotherapy six weeks after my surgery.My last treatment was April 1st.
I then called the XXXXXXX Clinic one of the best hospitals in the U.S. I was shocked a surgeon called me and gave me his cell phone number.He is world famous.He wants me to come next week for a cat scan and a pet scan.He was shocked I had never had a pet scan.He said after reading my cat scan his initial response was a partial resection for the 1cm tumors and ablation for the sub centimeters and then an infusion pump.
Yesterday I met a local interventional radiologist.He said do not have surgery as you will lose too much of your liver and some disease will probably come back.He knew about the infusion pump but was a little concerned as he had heard it causes liver damage from toxicity.He talked about several options and I have a follow up appointment with him on September 6th.He said someone needed to take control of my case and handle my care.He said he would do that.
XXXXXXX Kettering invented the infusion pump and every article I read says it prolongs your live over standard chemotherapy.If you put into your browser hepatic arterial infusion pump you will see many studies to support longer life over standard chemotherapy.I had an appointment at XXXXXXX Kettering but cancelled it as I need to process all of the information and advise I have been given by many doctors.
The radiologist talked about killing the existing tumors with hot or cold needles.He also said I could come in once a month and have chemo directed into my liver.He suggested systemic chemotherapy I think because he may think the cancer may spread.Thus far it has been confined to my liver.
My goal is simple.I can not withstand the standard chemo I received for 18 treatment.It served it purpose but my quality of life was terrible.For 10 months it was either in bed or the couch.I was afraid to eat as my bowel movements were too painful.I had no appetite.So I want to kill the cancer I have in my liver if possible and have some type of treatment but not systemic chemotherapy.
As I mentioned XXXXXXX Kettering invented the pump and my doctor at the XXXXXXX clinic has used it before however my local oncologist,the oncologist at the University of XXXXXXX do not like it.Both want me to enter a BRAF trial of Chemotherapy.I do not want this.
To confuse matters even more this is what I received from MD XXXXXXX yesterday
Hi Mr. XXXX,
Most studies looking at the use of hepatic arterial infusions for the treatment of metastatic colon cancer in the liver have not demonstrated an improvement in survival compared to chemotherapy alone. It's currently not a standard of care treatment, but it is used in select centers for select patients. It is not our practice to use this treatment due to lack of survival benefit and increased risk for liver damage.
I think the excerpt above from our website is referring to treatment options for hepatocellular carcinoma, or primary liver cancer, as opposed to cancer that started in the colon and has now spread into the liver. For example, we also do not use the drug sorafenib for treatment of metastatic colon cancer; that drug is only approved for the treatment of hepatocellular carcinoma and renal cell carcinoma (kidney cancer).
I spoke with Dr. Dasari again about your case, and he is happy to give you a formal opinion on your best treatment options if you can come for a visit here. I know this is less than convenient, but we are unable to give opinions over the phone or by e-mail without seeing you again.
I hope this information helps.
XXXXXXX
So I will go to the XXXXXXX Clinic and see what they have to say and then the radiologist who will talk to my two local oncologists.
THank you for all of your kind advise
XXXXXXX
Brief Answer:
Hi again
Detailed Answer:
Yes,it is very difficult to process all this information even for me as a hepatobiliary surgeon. Of course,every treatment has its pros and cons.there is no perfect one and there is no some that we could guarantee for to be efficient. there is lack of scientific data especially for new methods since there are no many patients enrolled in such treatments and trials. Also, surgeons may prefer surgery to boast his own confidence and ego,oncologist want trials since new chemo can be tested and he would get benefits from those. radiologist wants to try with his methods...unfortunately,they all have their interest in this case and no one will evaluate your condition objectively. what I can tell is that surgery should not be an option,it would be risky and I am sure that all tumors can't be removed,and also there are micrometastases for sure which may become apparent in next CT scan so this is for chemotherapy which can be delivered by pump or by systemic means. PET scan should have been done of course much earlier.... I hope that the right treatment will be found and that your doctors will agree about this. oncologist should be the team leader and collect all experiences and recommendation from other doctors and then decide about treatment plan..
Hi again
Detailed Answer:
Yes,it is very difficult to process all this information even for me as a hepatobiliary surgeon. Of course,every treatment has its pros and cons.there is no perfect one and there is no some that we could guarantee for to be efficient. there is lack of scientific data especially for new methods since there are no many patients enrolled in such treatments and trials. Also, surgeons may prefer surgery to boast his own confidence and ego,oncologist want trials since new chemo can be tested and he would get benefits from those. radiologist wants to try with his methods...unfortunately,they all have their interest in this case and no one will evaluate your condition objectively. what I can tell is that surgery should not be an option,it would be risky and I am sure that all tumors can't be removed,and also there are micrometastases for sure which may become apparent in next CT scan so this is for chemotherapy which can be delivered by pump or by systemic means. PET scan should have been done of course much earlier.... I hope that the right treatment will be found and that your doctors will agree about this. oncologist should be the team leader and collect all experiences and recommendation from other doctors and then decide about treatment plan..
Above answer was peer-reviewed by :
Dr. Yogesh D
Hi Doctor Rommstein,
I should be going to XXXXXXX clinic next week to meet with one of the best liver surgeons and their top oncologist.This is a first.In the past I only meet with one or the other.The surgeon is world famous.I do not think with the bRAF gene and the prior recurrence he will just surgery unless the oncologist comes up with immediate treatment to keep the tumors from coming back.
Other than the operation and all of the potential risks does a second resection pose any other problems as I am told you liver grows back.I was told by the radiologist not to have surgery as it would remove healthy tissue.My question is when it regrows is the new growth as healthy as what was removed? Is the regrowth the same as the original liver.
I was told by the oncologist that one option was surgery and immediate placement of the hepatic infusion pump.Would that not kill the micrometastases
Just like the Folfox/Avistin and Folfiri/Avstin did with 18 treatments.All tumors were dead after the large one was removed and that was 1/2 dead.
My concern is quality of life.For ten months I was extremely fatigued.I was either on the couch or in bed.I was afraid to eat because the pain of a bowel movement was to great and keeping my weight was very difficult.
In retrospect this cancer started maybe two years ago which the radiologist confirmed.I had many symptoms but did nothing about it.
Since I healed from surgery I have never had more energy,a better appetite and my bowel movements have been normal.I feel much better than before I was diagnosed with cancer.
Is surgery you are against even with the pumo what would happen if I had no surgery but they implanted the pump.Would this not kill what is currently in my liver just like the original chemo did? One other option the radiologist mentioned is ablation either with heat or cold.
Needless to say my intent is to get rid of what is there,keep it from returning and have quality of life.
I am very strong both mentally and physically.It was my body that took the original chemotherapy and turned it into a cancer killer.As I was told what I was given would not likly be effective with BRAF.I am sure with most people that would be true but it was not with me.
Thank you for all of your advise.
I should be going to XXXXXXX clinic next week to meet with one of the best liver surgeons and their top oncologist.This is a first.In the past I only meet with one or the other.The surgeon is world famous.I do not think with the bRAF gene and the prior recurrence he will just surgery unless the oncologist comes up with immediate treatment to keep the tumors from coming back.
Other than the operation and all of the potential risks does a second resection pose any other problems as I am told you liver grows back.I was told by the radiologist not to have surgery as it would remove healthy tissue.My question is when it regrows is the new growth as healthy as what was removed? Is the regrowth the same as the original liver.
I was told by the oncologist that one option was surgery and immediate placement of the hepatic infusion pump.Would that not kill the micrometastases
Just like the Folfox/Avistin and Folfiri/Avstin did with 18 treatments.All tumors were dead after the large one was removed and that was 1/2 dead.
My concern is quality of life.For ten months I was extremely fatigued.I was either on the couch or in bed.I was afraid to eat because the pain of a bowel movement was to great and keeping my weight was very difficult.
In retrospect this cancer started maybe two years ago which the radiologist confirmed.I had many symptoms but did nothing about it.
Since I healed from surgery I have never had more energy,a better appetite and my bowel movements have been normal.I feel much better than before I was diagnosed with cancer.
Is surgery you are against even with the pumo what would happen if I had no surgery but they implanted the pump.Would this not kill what is currently in my liver just like the original chemo did? One other option the radiologist mentioned is ablation either with heat or cold.
Needless to say my intent is to get rid of what is there,keep it from returning and have quality of life.
I am very strong both mentally and physically.It was my body that took the original chemotherapy and turned it into a cancer killer.As I was told what I was given would not likly be effective with BRAF.I am sure with most people that would be true but it was not with me.
Thank you for all of your advise.
Brief Answer:
Hi again
Detailed Answer:
Liver surgery is complex. There is high risk of bleeding and septic complications especially when large amount of tissue must be resected. Liver regrows, that is true but also some time is required till it grows again and this is usually 2-3 months. In case of surgery, there is a danger of removing too much tissue so liver failure and deah may occur especially if less than 40% of liver is left.
So for multiple metastases it may be too risky to perform surgery and even if this is succesful, there may be new micrometastases and then everything would be useless.
I understand your wish to have better quality of life but such aggresive tumors require agressive treatment and each of these has its side effects. I am not so convinced that it can be completely cured since there is diffuse liver involvement,but some slowing down of there progression is one reasonable expectation.
I repeat , I should see CT images to give better evaluation of possible surgical resection but considering all this, surgery is the worst option. It would be better to start chemo or the pump and when/if tumors shrink then surgery can be considered. Heat or cold ablation is palliative method, it rarely kill all tumor cells..
Hi again
Detailed Answer:
Liver surgery is complex. There is high risk of bleeding and septic complications especially when large amount of tissue must be resected. Liver regrows, that is true but also some time is required till it grows again and this is usually 2-3 months. In case of surgery, there is a danger of removing too much tissue so liver failure and deah may occur especially if less than 40% of liver is left.
So for multiple metastases it may be too risky to perform surgery and even if this is succesful, there may be new micrometastases and then everything would be useless.
I understand your wish to have better quality of life but such aggresive tumors require agressive treatment and each of these has its side effects. I am not so convinced that it can be completely cured since there is diffuse liver involvement,but some slowing down of there progression is one reasonable expectation.
I repeat , I should see CT images to give better evaluation of possible surgical resection but considering all this, surgery is the worst option. It would be better to start chemo or the pump and when/if tumors shrink then surgery can be considered. Heat or cold ablation is palliative method, it rarely kill all tumor cells..
Above answer was peer-reviewed by :
Dr. Prasad
Hi Doctor.
Thank you for your advise.My mistake even dealing with one of the best cancer hospitals in the world XXXXXXX XXXXXXX was only talking to the surgeon. I doubt if he reviewed this with an oncologist as they would have known that the BRAF gene would return to my liver.At the XXXXXXX Clinic I will be talking to one of the best livrer surgeons in the U.S. and an oncologist and certainly,if surgery is suggested,inquire how can you be confident the lesions will not reappear.I think the hepatic arterial infusion pump has much less side effects than systemic chemotherapy as it is confined to the liver and then expelled by the liver. I was also told there is a procedure where once per month you can get direct infusions into your liver.
If ablation is used then if there are any tumor cells left wont the pump kill them?
Is there any reason to believe that the pump would not be as effective as systemic chemotherapy?
I have a very strong body and mind.I think I can tolerate many things that others may not be able to.The problem with the Folfox or Folfiri with Avastin for 18 treatments was fatigue and very painful constipation as well as never feeling hungry.
The radiation oncologist said the seven lesions I now have were there when I had surgery but were microscopic.If true maybe it is not so bad as the largest is 1cm and I have not had chemotherapy since April 1st.
I greatly appreciate all of the advise you have given me.The difficult thing is now deciding with all of the conflicting doctors advise is what route to take.
Thank you again
XXXXXXX
Hi Doctor,
Could this be an option for me?
Multidisciplinary Liver Tumor Care
When liver tumor patients at the University of Michigan receive this therapy, it means that doctors and nurses are providing cancer care according to a personalized treatment plan developed by specialists in the U-M Comprehensive Cancer Center's multidisciplinary tumor program. Members are experts in hepatology, surgery, medical oncology, radiation oncology, and diagnostic and interventional radiology. Their frequent meetings allow patients to have the expertise of a multidisciplinary team of physicians with a focus on liver cancer - without having to schedule individual appointments.
What to expect
Patients receive TACE therapy when their cancer began in the liver (primary liver cancer), or spread to the liver from another area (secondary liver cancer or metastasis), and the tumor is classed at the intermediate stage. The goal of chemoembolization is to extend survival, relieve pain, and alleviate symptoms. Some patients with intermediate stage of primary liver cancer can be "down-staged" such that they can become candidates for a liver transplant. For some patients, TACE is used while they are waiting on the transplant list for an organ to become available. In this circumstance, the therapy is called a 'bridge to transplant.' Many of our liver cancer experts also see patients at the U-M Transplantation Center, assuring the delivery of comprehensive care.
Thank you,
XXXXXXX
Thank you for your advise.My mistake even dealing with one of the best cancer hospitals in the world XXXXXXX XXXXXXX was only talking to the surgeon. I doubt if he reviewed this with an oncologist as they would have known that the BRAF gene would return to my liver.At the XXXXXXX Clinic I will be talking to one of the best livrer surgeons in the U.S. and an oncologist and certainly,if surgery is suggested,inquire how can you be confident the lesions will not reappear.I think the hepatic arterial infusion pump has much less side effects than systemic chemotherapy as it is confined to the liver and then expelled by the liver. I was also told there is a procedure where once per month you can get direct infusions into your liver.
If ablation is used then if there are any tumor cells left wont the pump kill them?
Is there any reason to believe that the pump would not be as effective as systemic chemotherapy?
I have a very strong body and mind.I think I can tolerate many things that others may not be able to.The problem with the Folfox or Folfiri with Avastin for 18 treatments was fatigue and very painful constipation as well as never feeling hungry.
The radiation oncologist said the seven lesions I now have were there when I had surgery but were microscopic.If true maybe it is not so bad as the largest is 1cm and I have not had chemotherapy since April 1st.
I greatly appreciate all of the advise you have given me.The difficult thing is now deciding with all of the conflicting doctors advise is what route to take.
Thank you again
XXXXXXX
Hi Doctor,
Could this be an option for me?
Multidisciplinary Liver Tumor Care
When liver tumor patients at the University of Michigan receive this therapy, it means that doctors and nurses are providing cancer care according to a personalized treatment plan developed by specialists in the U-M Comprehensive Cancer Center's multidisciplinary tumor program. Members are experts in hepatology, surgery, medical oncology, radiation oncology, and diagnostic and interventional radiology. Their frequent meetings allow patients to have the expertise of a multidisciplinary team of physicians with a focus on liver cancer - without having to schedule individual appointments.
What to expect
Patients receive TACE therapy when their cancer began in the liver (primary liver cancer), or spread to the liver from another area (secondary liver cancer or metastasis), and the tumor is classed at the intermediate stage. The goal of chemoembolization is to extend survival, relieve pain, and alleviate symptoms. Some patients with intermediate stage of primary liver cancer can be "down-staged" such that they can become candidates for a liver transplant. For some patients, TACE is used while they are waiting on the transplant list for an organ to become available. In this circumstance, the therapy is called a 'bridge to transplant.' Many of our liver cancer experts also see patients at the U-M Transplantation Center, assuring the delivery of comprehensive care.
Thank you,
XXXXXXX
Brief Answer:
Hi
Detailed Answer:
I am glad that I can help you and I am sure that you are consulting best doctors in USA but also the advantage of our web advice platform is to give honest and objective recommendation. as I already said,each specialist may prefer some kind treatment and in some cases there is no medical indication but only some type of experimentation. doctors want to try new and modern methods and oncologic patients are good customers for it.
Surgery and chemotherapy are standard and the only curative treAtment for liver cancer,bit primary and secondary. all other methods are palliative,and it means that complete remission is not possible. I am saying this so that you can understand that you should not look for magical cure with TACE,pump or ablation but you should look for therapy which will lead to best possible quality of life and slow down tumor progression maximally.there is no point of aggressive therapy with TACE if you are gonna die of its complications.TACE is used for HCC ,rarely for colorectal metastasis and usually unless to liver atrophy and you may die of liver failure. it will not bring chemotherapeuric to liver better than pump will do.
the strategy for your case is not simple,but I don't think that you should look for other methods but pump it chemo at this point. it can always be replaced with another methods if aren't successful after1-3 months. but I suggest to start with chemotherapy or pump,then do MRI scan after 4 cycles and then if 3 or less lesions are present,surgery may be an option. I am not sure if all these doctors can have better conclusion. soon ,you will see if there is dissemination or not,but therapy should not be delayed anymore. I hope it will be positive,and that you can handle all this. inform me about further progress and their decision. also,it would be good to do PET scan before treatment starts.
Hi
Detailed Answer:
I am glad that I can help you and I am sure that you are consulting best doctors in USA but also the advantage of our web advice platform is to give honest and objective recommendation. as I already said,each specialist may prefer some kind treatment and in some cases there is no medical indication but only some type of experimentation. doctors want to try new and modern methods and oncologic patients are good customers for it.
Surgery and chemotherapy are standard and the only curative treAtment for liver cancer,bit primary and secondary. all other methods are palliative,and it means that complete remission is not possible. I am saying this so that you can understand that you should not look for magical cure with TACE,pump or ablation but you should look for therapy which will lead to best possible quality of life and slow down tumor progression maximally.there is no point of aggressive therapy with TACE if you are gonna die of its complications.TACE is used for HCC ,rarely for colorectal metastasis and usually unless to liver atrophy and you may die of liver failure. it will not bring chemotherapeuric to liver better than pump will do.
the strategy for your case is not simple,but I don't think that you should look for other methods but pump it chemo at this point. it can always be replaced with another methods if aren't successful after1-3 months. but I suggest to start with chemotherapy or pump,then do MRI scan after 4 cycles and then if 3 or less lesions are present,surgery may be an option. I am not sure if all these doctors can have better conclusion. soon ,you will see if there is dissemination or not,but therapy should not be delayed anymore. I hope it will be positive,and that you can handle all this. inform me about further progress and their decision. also,it would be good to do PET scan before treatment starts.
Above answer was peer-reviewed by :
Dr. Kampana
Hi Doctor,
Not good news from the XXXXXXX clinic and my MRI yesterday.Threre weeks ago I had seven lesions in my liver 4 1cm and 3 sub cm. This is what my MRI of my liver showed yesterday in only three weeks.
1.1x1.0
1.7x1.6
2.0x1.4
1.5x1.0
1.9x1.8
1.1x0.9
1.9x1.5
2.1x1.6
1.3x1.0
1.8x1.5
It also showed a 1.7 lesion in my pancreas.Both oncologistys says it 99.99% is the BRAF from my colon not pancreatic cancer.
The BRAF trial I mentioned is being held throughout the U.S.It is just adding a few drugs to the standard chemotheraphy regieme
http://www.ascopost.com/issues/february-10-2017/dual-inhibition-proves-effective-for-braf-mutated-colorectal-tumors/
I will have this done at the University of XXXXXXX This was the doctor when I first was diagnosed with colon cancer set me up with Folfox with Avastin and Folfiri with Avastin.Although he was very concerned if BRAF would respond it was the only option.After 18 treatments it killed the 21 tumors.In surgery one was 1/2 dead and they removed it with the 10% of my liver.Needless to say unless you tell me otherwise the pump is not an option now?
If you have any other suggestions please let me know.
Thank you as always
XXXXXXX
Not good news from the XXXXXXX clinic and my MRI yesterday.Threre weeks ago I had seven lesions in my liver 4 1cm and 3 sub cm. This is what my MRI of my liver showed yesterday in only three weeks.
1.1x1.0
1.7x1.6
2.0x1.4
1.5x1.0
1.9x1.8
1.1x0.9
1.9x1.5
2.1x1.6
1.3x1.0
1.8x1.5
It also showed a 1.7 lesion in my pancreas.Both oncologistys says it 99.99% is the BRAF from my colon not pancreatic cancer.
The BRAF trial I mentioned is being held throughout the U.S.It is just adding a few drugs to the standard chemotheraphy regieme
http://www.ascopost.com/issues/february-10-2017/dual-inhibition-proves-effective-for-braf-mutated-colorectal-tumors/
I will have this done at the University of XXXXXXX This was the doctor when I first was diagnosed with colon cancer set me up with Folfox with Avastin and Folfiri with Avastin.Although he was very concerned if BRAF would respond it was the only option.After 18 treatments it killed the 21 tumors.In surgery one was 1/2 dead and they removed it with the 10% of my liver.Needless to say unless you tell me otherwise the pump is not an option now?
If you have any other suggestions please let me know.
Thank you as always
XXXXXXX
Brief Answer:
Hi
Detailed Answer:
hi XXXXXXX
I am sorry to hear this my friend,but I am not surprised since tumors after dissemination in liver usually grow and multiply rapidly especially if chemotherapy was already done so many times. this is bad sign of course,bit don't lose hope. you will have to accept trial,don't calculate with other methods anymore. you have to accept aggressive therapy no matter how unpleasant side effects may be. few years ago,BRAF and RAS tests were not known at all,and there was no other chemoth but folfiri,so you are relatively lucky that you live in USA where trials are available and modern oncology study new treatment options intensively so new advances in this field may be expected.so you should follow recommmendations of oncologists in high volume hospitals. You have nothing to lose at this point,chemo must be started and we can hope that there will be some response. my prayers are with you. contact me and inform about further steps at any time.
Hi
Detailed Answer:
hi XXXXXXX
I am sorry to hear this my friend,but I am not surprised since tumors after dissemination in liver usually grow and multiply rapidly especially if chemotherapy was already done so many times. this is bad sign of course,bit don't lose hope. you will have to accept trial,don't calculate with other methods anymore. you have to accept aggressive therapy no matter how unpleasant side effects may be. few years ago,BRAF and RAS tests were not known at all,and there was no other chemoth but folfiri,so you are relatively lucky that you live in USA where trials are available and modern oncology study new treatment options intensively so new advances in this field may be expected.so you should follow recommmendations of oncologists in high volume hospitals. You have nothing to lose at this point,chemo must be started and we can hope that there will be some response. my prayers are with you. contact me and inform about further steps at any time.
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Above answer was peer-reviewed by :
Dr. Raju A.T
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