Implementing Hepatic Artery Infusion Pump Programs With Sepideh Gholami, MD, MAS, FACS, FSSO
Recently, Sepideh Gholami implemented a Hepatic Artery Infusion Pump Program at Northwell Health. In this interview, Dr. Gholami discusses what exactly a hepatic artery infusion pump is, its benefits, and how it will affect the future treatment landscape of cancers as a whole. As well, she advocates for the implementation of these programs in more institutions across the nation.
Oncology Data Advisor: Thank you, Dr. Gholami, for being here today to talk about this important subject. Would you like to first start with introducing yourself, what you do, and your research interest?
Sepideh Gholami, MD, MAS, FACS, FSSO: Yes. Thank you so much for having me. I am Dr. Gholami, and I'm a Surgical Oncologist and Hepatobiliary Surgeon at Northwell Health. I also have a lab component at Cold Spring Harbor Laboratory where we study liver metastases from colorectal cancer, and specifically trying to really focus on the development of new immune-augmenting drugs for patients with colon cancer.
Oncology Data Advisor: We are so excited to have you here today to talk about the hepatic artery infusion pump. So, first question I wanted to ask just to start things off, is what is a hepatic artery infusion pump?
Dr. Gholami: This is a good question. I would say it is really not a novel treatment. It is a very old treatment modality that is considered locoregional treatment for patients with colon cancer with liver metastases, as well as patients with intrahepatic cholangiocarcinoma currently that are not resectable.
So, essentially, it's a stronger version of local regional therapy that we combine with systemic chemotherapy in order to treat the tumors within the liver at a much higher dose to get ultimately a deeper treatment response and improve the oncologic outcomes for these types of patients.
Oncology Data Advisor: I know you just briefly started to mention how this can provide a deeper response, but I wanted to ask if you could go into more detail on how using a hepatic artery infusion pump is beneficial for the patients.
Dr. Gholami: I would say that the clinical data we have for patients so far with colon cancer and liver metastases is in such a way that for patients who have unresectable disease with giving the hepatic artery infusion chemotherapy with a systemic, we achieve about a 40% to 50% of a conversion to resectability rate with using that combination of treatment. Meaning when someone is unresectable with their baseline scans and the surgeon cannot take the tumors out, there's a chance of about 50% after six months of treatment roughly with the combination therapy to get them to be a surgical candidate.
Then, we therefore also know that once you are a surgical candidate for basically undergoing metastasectomy for liver metastases for colorectal cancer, that in turn will increase your survival outcome. So, I would say there's good data that is still mostly single institution based on clinical trial data that has shown both increase in the disease control and local progression rate within the liver as well as overall survival. There is currently a recent multi-institutional trial across the US with several centers that's going to answer this particular question. So, it'd be really interesting to see if those results still hold up when the studies are open across the US.
Oncology Data Advisor: Definitely. It will be exciting to hear updates on this, and I was going to ask you near the end, but I'll go ahead and ask you now since we're on this subject. Were there any previous, current, or future clinical trials studying this technology that you'd like to bring awareness to?
Dr. Gholami: There are several trials I would say with this technology that again, like I mentioned, is really not new. We have trial data with patients that I mentioned already in the unresectable setting and with the hope to really get them to become surgical candidates. There are data available from clinical trials in the adjuvant setting, so patients who underwent already resection of the liver metastasis and then received pump chemotherapy with systemic therapy. That also showed improved survival.
There was a very large series of over 2,000 patients in which those patients were retrospectively studied from a single center that's been reviewed. It clearly shows survival benefits. Granted, that is retrospective, so it needs to be taken with a caveat based on selection of the patients who are included in those studies and how they were treated.
I would say, overall, there's a pretty strong amount of evidence really for the benefit of this, for these group of patients, and we really are excited to find out how the next trials will turn out to be. The trial I mentioned that is open now is through the National Clinical Trials Network (NCTN), and that is a multi-institutional study. And then, I would say the next trial will be, again, a multi-institutional trial for the adjuvant setting, which we still need to also investigate further.
Oncology Data Advisor: What kind of cancers can be treated with a hepatic artery infusion pump?
Dr. Gholami: I would say that right now, the treatments that are approved and well-accepted are patients with colon cancer that have liver metastases without true evidence of extrahepatic disease. So, there are diseases really focused in the liver. The other group of patients are patients with intrahepatic cholangiocarcinoma that is not resectable. Those patients are also offered pump chemotherapy with systemic together. There's also currently a multi-institutional trial for that group of patients that's going to be randomized, and we are still awaiting results from that.
Oncology Data Advisor: How does this technology, in your opinion, affect the future treatment landscape of cancers as a whole?
Dr. Gholami: I think right now, the indications are still fairly narrow for this, but I think there are novel ways of thinking sort of outside the box and adding new treatment regimens through the pump. Right now, we're still using a very old drug called floxuridine (FUDR), which is a derivative of 5-fluorouracil (5-FU).
But I think what would be exciting is trying novel therapeutics through the pump and delivering that to the liver as well as other sorts of regional arterial therapies that are also on the market that are currently under investigation.
So, just thinking of the liver as a sort of immune resistant environment currently, we really need to defend treatment strategies instead of the garden variety sort of systemic chemotherapies that we have currently available. So, it's not particularly just this pump alone, but I think just kind of overall thinking outside the box and kind of where the field is headed. I think the landscape will hopefully change in the next couple of years.
Oncology Data Advisor: Final question that I wanted to ask you is, in your own work, how have you been implementing the infusion pump at Northwell?
Dr. Gholami: The hepatic artery infusion pump at Northwell started just about a year ago when I started here, and we've now treated over six patients—and one of my old patients from California, so that was patient number seven. We have three more upcoming cases this month. So, I think we're expanding rapidly. And so far, I've been really happy with the teamwork and the patient care and everything that we've provided. I think it's really nice to be able to provide, again, just another option and modality to these groups of patients that is really desperately needed, so they can stay local and don't have to travel far in order to get various options at least offered to them.
Oncology Data Advisor: Thank you so much for leading this charge by providing these new options for your patients. Thank you so much for being here today and talking to me about this, Dr. Gholami.
Dr. Gholami: Of course. Thank you so much for the invitation. I appreciate it.
About Dr. Gholami
Sepideh Gholami, MD, MAS, FACS, FSSO, is the Director of the Hepatic Artery Infusion Pump Program, Liver Multidisciplinary Clinic, and Translational Research in Surgical Oncology at Northwell Health. Her research interest focuses on liver-directed therapies and implementing multidisciplinary liver surgery programs. With an extensive clinical trial portfolio herself, Dr. Gholami is passionate about improving, diversifying, and expanding upon the research and clinical trial portfolio at Northwell as a whole.
For More Information
Northwell Health (2023). Northwell launches targeted liver cancer treatment program on Long Island. Available at: https://www.northwell.edu/news/the-latest/northwell-launches-targeted-liver-cancer-treatment-program-on-long-island
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.