4 mei 2017: Bron: Journal of Clinical Oncology

Inmiddels is het studierapport van de Nederlandse oncoloog Bart Groot Koerkamp online gepubliceerd in het Journal of Clinical Oncology.

Het volledige studierapport: Perioperative Hepatic Arterial Infusion Pump Chemotherapy Is Associated With Longer Survival After Resection of Colorectal Liver Metastases: A Propensity Score Analysis is gratis in te zien. Het blijft heel raar dat ondanks alle bewijzen dat HAIPO voortreffeljke resultaten laat zien dat in Nederland / Europa nog een nieuwe gerandomiseerde placebo gecontroleerde fase III studie moet plaatsvinden. Met dus als uitkomst dat zeker tientallen mensen met in de lever uitgezaaide darmkanker onnodig vroegtijdig zullen overlijden.Ik vraag me af of we wellicht in samenwerking met patiënten organisaties hiertegen actie moeten ondernemen? Ik ga het in ieder geval voorleggen aan mijn collega's patient advocates binnen Inspire2live. (Tekst gaat verder onder grafiek)

HAIP grafiek

Het abstract staat onderaan dit artikel.

21 april 2017: Bron: AD en J Gastrointest Oncology

Het Algemeen Dagblad komt vandaag 21 april 2017 met een ervaringsverhaal van een Nederlandse man, Cas Renders die al in 2000 met HAIP - hepatic arterial infusion pump therapy is behandeld in het Memorial Sloan Kettering in New York voor zijn in de lever uitgezaaide darmkanker en in 2000 nog slechts een levensverwachting van drie maanden kreeg.  En met succes want hij is 17 jaar later (hij is nu 54 jaar) nog steeds kankervrij. Een mooi ervaringsverhaal maar de manier van behandelen wordt al heel lang toegepast in Amerika.

HAIP pompHAIP pomp

HAIP - hepatic arterial infusion pump therapy is al een oude techniek die vooral in Amerika veel wordt toegepast. Vooral bij primaire leverkanker maar ook bij operabele in de lever uitgezaaide darmkanker. In feite is dit TACE - chemo embolisatie zoals ook dr. Vogl die toepast maar omdat het pompje in de lever wordt geplaatst bij de operatieve verwijdering van de tumoren kan deze chemo embolisatie zonder extra belasting voor de patiënt om de twee weken worden uitgevoerd.

Bekijk deze video hoe HAIP wordt uitgevoerd: Treating Liver Metastases with Hepatic Arterial Infusion Therapy

Een uitstekende review studie over HAIP - hepatic arterial infusion pump therapy is deze studie: Hepatic resection, hepatic arterial infusion pump therapy, and genetic biomarkers in the management of hepatic metastases from colorectal cancer

In this review, we discuss surgical treatment and associated outcomes in the treatment of CRLM. In addition, the role and efficacy of HAI therapy are examined. Finally, we outline how genetic profiling and mutational analysis can impact management of this disease in this era of molecular-based targeted therapies. Abstract sataat hieronder met referentielijst.

Tekst gaat onder foto verder

HAIP pomp mechanisme

Foto: Werkingsmechanisme van HAIP therapy

Chirurg-oncoloog Bas Groot Koerkamp deed onderzoek naar de resultaten van HAIP bij 2000 Amerikaanse patienten en uit zijn onderzoek blijkt dat mediaan de patienten 2 jaar langer leefden dan alleen met systemische chemo. Maar blijkbaar is dit bewijs niet voldoende om dit aan Nederlandse en Belgische patienten aan te bieden want er komt nu eerst een gerandomiseerde placebo gecontroleerde fase III studie. Het is toch van de gekke dat na zoveel bewijs (google op HAIP - hepatic arterial infusion pump therapy en u vindt tientallen studies) er weer opnieuw een studie moet worden gedaan. Trots wordt in het artikel in het AD vermeldt dat het KWF deze studie financiert. Wat een verspilling van tijd en geld gen koste van kankerpatiënten, wetende dat deze manier van behandelen spotgoedkoop is in vergelijking met de nieuwere medicijnen en dat er nog weer een placebo gecontroleerde fase III studie mee moet worden gedaan. SCHANDALIG

Hier een citaat uit het artikel in het Algemeen Dagblad d.d. 21 april 2017

Langer leven dankzij simpel chemopompje

Mensen met darmkanker en uitzaaiingen in de lever kunnen spectaculair langer leven door een speciale chemopomp. Dat blijkt uit onderzoek van het Erasmus MC onder Amerikaanse patiënten. Het apparaat komt nu naar Nederland.........

Cas Renders (54) uit Amsterdam is het levende bewijs. In 2000 – op zijn 38ste – gaven artsen hem 4 procent kans om te overleven ,,Of wel: over 3 maanden bent u er niet meer.” Hij gaf niet op en kwam bij kankercentrum Sloan Kettering in New York terecht.

Daar plaatsen ze het pompje ter grootte van een ijshockeypuck net onder zijn huid en spuiten er om de twee weken chemovloeistof in, zes keer in totaal. Groot Koerkamp: ,,De pomp zit op de slagader en voert direct chemo de lever in. Omdat het ook alleen dáár blijft, kun je een heel hoge concentratie gebruiken.” Bijkomend voordeel: de patiënt heeft nauwelijks last van bijwerkingen die horen bij chemokuren via een infuus, zoals misselijkheid en haarverlies. Lees het volledige artikel in het AD>>>>>>>>>>

Het volledige studierapport Hepatic resection, hepatic arterial infusion pump therapy, and genetic biomarkers in the management of hepatic metastases from colorectal cancer is gratis in te zien.

Hier het abstract met referentielijst

HAI chemotherapy has also evolved, and provides a unique and effective therapy both in the unresectable setting and as an adjuvant therapy following resection seemingly beyond that of systemic therapies alone.

J Gastrointest Oncol. 2015 Dec; 6(6): 699–708.
PMCID: PMC4671858

Hepatic resection, hepatic arterial infusion pump therapy, and genetic biomarkers in the management of hepatic metastases from colorectal cancer

John C. McAuliffe, Motaz Qadan, and Michael I. D’Angelica
corresponding author

Abstract

The liver is the most common site of colorectal cancer metastasis. Fortunately, improvements have been made in the care of patients with colorectal liver metastasis (CRLM). Effective management of CRLM requires a multidisciplinary approach that is tailored to individuals in order to achieve long-term survival, and cure. Resection and systemic chemotherapy provides benefit in selected individuals. An adjunct to resection and/or systemic chemotherapy is the use of hepatic arterial infusion pump (HAIP) therapy. Many studies show HAIP provides benefit for select patients with CRLM. Added to the crucible of a multidisciplinary approach to managing CRLM is the ever growing understanding of tumor biology and genetic profiling. In this review, we discuss the outcomes of resection, systemic therapies and HAIP therapy for CRLM. We also discuss the impact of recent advances in genetic profiling and mutational analysis, namely mutation of KRAS and BRAF, for this disease.

Conclusions

During the last three decades, there has been progressive improvement in the management of CRLM. Hepatic resection is performed with low risk at high-volume specialized centers, and has been established as the standard of care for resectable disease with associated prolonged survival and potential for cure. Likewise, systemic therapies have improved, with the advent of novel cytotoxic systemic chemotherapeutic agents. Furthermore, targeted therapies are now applied to contemporary drug regimens and have modestly improved outcomes in patients with mCRC. HAI chemotherapy has also evolved, and provides a unique and effective therapy both in the unresectable setting and as an adjuvant therapy following resection seemingly beyond that of systemic therapies alone. Multidisciplinary care for each patient with CRLM is crucial to orchestrate the multiple management strategies to extent survival. Combining clinical features with molecular profiling may provide superior prognostication for patients with CRLM. The promise of individualized therapy, tailored according to specific genetic mutations and disease patterns, is now being realized and continues to evolve.

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Acknowledgements

None.

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Footnotes

Conflicts of Interest: The authors have no conflicts of interest to declare.

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Articles from Journal of Gastrointestinal Oncology are provided here courtesy of AME Publications

Use of perioperative hepatic arterial infusion pump chemotherapy after complete resection of colorectal liver metastases is associated with a marked improvement in overall survival compared with systemic chemotherapy without hepatic arterial infusion

DOI: 10.1200/JCO.2016.71.8346 Journal of Clinical Oncology - published online before print April 20, 2017

Perioperative Hepatic Arterial Infusion Pump Chemotherapy Is Associated With Longer Survival After Resection of Colorectal Liver Metastases: A Propensity Score Analysis

Bas Groot Koerkamp, Eran Sadot, Nancy E. Kemeny, Mithat Gönen, Julie N. Leal, Peter J. Allen, Andrea Cercek, Ronald P. DeMatteo, T. Peter Kingham, William R. Jarnagin, and Michael I. D’Angelica

Bas Groot Koerkamp, Eran Sadot, Nancy E. Kemeny, Mithat Gönen, Julie N. Leal, Peter J. Allen, Andrea Cercek, Ronald P. DeMatteo, T. Peter Kingham, William R. Jarnagin, and Michael I. D’Angelica, Memorial Sloan Kettering Cancer Center, New York, NY; Bas Groot Koerkamp, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; and Eran Sadot, Rabin Medical Center, Petah Tikva, and Tel Aviv University, Tel Aviv, Israel.

Abstract

Purpose

To investigate whether perioperative hepatic arterial infusion pump chemotherapy (HAI) was associated with overall survival (OS) in patients who had a complete resection of colorectal liver metastases (CLM).

Methods

Patients who underwent a complete resection of CLM between 1992 and 2012 were included from a single-center prospectively maintained database. All patients who received HAI also received perioperative systemic chemotherapy. Propensity score analysis was used to match patients for seven known prognostic factors.

Results

A total of 2,368 consecutive patients underwent a complete resection of CLM, with a median follow-up of 55 months. The median OS for patients with HAI (n = 785) was 67 months versus 44 months without HAI (n = 1,583; P < .001), despite more advanced disease in the HAI group. OS at 10 years was 38.0% versus 23.8% without HAI. For patients who received modern systemic chemotherapy (n = 1,442), the median OS was 67 months with HAI and 47 months without HAI (P < .001). The hazard ratio adjusted by propensity score demonstrated longer OS with HAI: 0.67 (95% CI, 0.59 to 0.76; P < .001). A pronounced difference in median OS was found for patients with node-negative colorectal cancer (129 months with HAI v 51 months without; P < .001) and a low clinical risk score of 0 to 2 points (89 months with HAI v 53 months without; P < .001).

Conclusion

Patients who received HAI had a median OS of approximately 2 years longer than patients without HAI. The strong association was independent of the use of modern systemic chemotherapy and remained in propensity score analysis. Patients with node-negative primary tumors or a low clinical risk score seemed to benefit most from HAI.

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Tace, Trans arteriele chemo embolisatie, uitgezaaide darmkanker, leveruitzaaiingen, overall overleving, operatie


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HAIP -(hepatic arterial infusion >> Arteriele chemo embolisatie >> TACE = Transarteriële Chemo >>