June 17, 2025
Extensive liver disease can make it impossible to completely resect tumors, resulting in low overall survival rates and a high risk of recurrence. But now, people with colorectal liver metastases or unresectable cholangiocarcinoma have access to innovative treatment through the Mayo Clinic hepatic artery infusion pump (HAIP) program. HAIP therapy helps shrink tumors by delivering high doses of chemotherapy directly to the liver through a surgically placed infusion pump.
"Our aim with this program is to expand the treatment options for patients who have been told they have no other options, leading to potentially curative intent surgery or transplantation," says Katherine Poruk, M.D., a surgical oncologist and leader of the HAIP program at Mayo Clinic in Jacksonville, Florida. Mayo Clinic is a leading center in the Southeast for HAIP therapy, and the program is the only one of its kind in the North Florida region.
Indications and advantages of HAIP therapy
Complete surgical resection is currently the only curative treatment for colorectal liver metastases and cholangiocarcinoma. However, most colorectal liver metastases present at an advanced stage, rendering them unresectable. Intrahepatic cholangiocarcinoma, a type of biliary tract malignancy, offers its own challenges. Complete resection is achieved only 33% of the time, leaving many patients with a higher than 60% risk of recurrence.
"With hepatic artery infusion pump, we can often achieve higher and more durable response rates than conventional IV therapy," says Dr. Poruk. Research shows that HAIP therapy may improve overall survival for people with colorectal liver metastases or unresectable cholangiocarcinoma. "Most importantly, it opens up the potential for curative options for patients who previously did not have those options."
HAIP therapy is currently a potential treatment option for adults with one of three indications:
- Unresectable colorectal liver metastases. Candidates for HAIP therapy have minimal disease outside of the liver and primary tumor, regardless of whether their primary tumor is still in place.
- Resectable colorectal liver metastases with a very high risk of recurrence. These patients may have disease progression after first line or second line chemotherapy, recurrent metastases, and multiple or disappearing lesions.
- Unresectable intrahepatic cholangiocarcinoma. Advanced biliary disease must not have metastasized outside the liver.
HAIP therapy, often used alongside other systemic therapies, has advantages that make it a more potent treatment for advanced disease. It provides a concentrated approach to chemotherapy that may effectively shrink the tumor. Downstaging the cancer can help control disease progression, improve quality of life and make the tumor viable for resection.
Because the strong chemotherapy agent is delivered directly to the liver, it is immediately metabolized and produces no additional systemic side effects. Dr. Poruk says patients are often surprised at how well they feel despite undergoing high doses of chemotherapy.
Using specialized expertise to treat liver metastases and cholangiocarcinoma
Mayo Clinic specialists understand the unique challenges associated with liver metastases and unresectable intrahepatic cholangiocarcinoma. They also know that careful selection of appropriate patients and specialized expertise is critical to effective treatment with HAIP therapy.
Dr. Poruk says they rely on a multidisciplinary team and tumor board, including medical and radiation, as well as surgical oncology, hepatology, transplant and other specialties, to evaluate patients for treatment. Patients undergo advanced imaging and assessments of the disease state and overall health to determine eligibility.
The specialists directly involved in placing the pump and managing HAIP therapy include:
- Surgeons who place the pump robotically whenever possible to provide easier postoperative recovery.
- Oncologists skilled in administering effective chemotherapy doses.
- Interventional radiologists trained in procedures used to ensure the pump works properly.
Once the pump is in place, the typical course of HAIP treatment lasts six months or as long as chemotherapy is needed. In many cases, HAIP chemotherapy continues until the patient is considered a candidate for either surgical resection of the tumors or potentially curative liver transplantation. Patients visit Mayo Clinic every two weeks for the duration of treatment, and the pump can be removed after treatment is completed.
Unlocking the potential of HAIP therapy
Researchers at Mayo Clinic are working to understand the full breadth of indications that might benefit from HAIP therapy. They also are studying the patients receiving HAIP therapy to identify its effect on disease outcomes.
"There is still a lot to learn, but we know that HAIP therapy does not close any doors," says Dr. Poruk. "For select patients, it can potentially open new avenues of treatment down the road."
For more information
Refer a patient to Mayo Clinic.