A surgeon specializing in hepatopancreatobiliary (HPB) procedures has launched a hepatic artery infusion (HAI) program while expanding research to identify tumor-specific characteristics that improve the treatment of liver, pancreatic, and bile duct cancers.

Michael E. Lidsky, MD, works to help extend the life expectancy of patients with primary and metastatic HPB cancers by developing personalized, holistic therapies. The surgical oncologist is also continuing long-term research into tumor-specific dependencies that he hopes will lead to more effective treatment.

Patients are commonly referred to Duke’s HPB cancer team following unsuccessful treatment at other medical centers, often arriving discouraged about the prognosis.

“But we talk about their concerns, answer their questions, and work to restore hope,” Lidsky says. “Watching the effort of these amazing patients is inspiring and increases our determination to push the envelope in our field and advance the research to improve outcomes.”

HAI is a therapy that facilitates the delivery of extremely high doses of chemotherapy directly to the liver via a surgically placed, subcutaneous, abdominal wall pump. Duke is the only medical center in the southeastern U.S. performing this liver-directed therapy.

HAI exploits liver physiology by delivering high doses of chemotherapy targeted to treat tumors through the hepatic artery. The healthy liver tissue is relatively protected from toxicity due to a secondary blood supply through the portal venous system.

The most common application of HAI is for the treatment of unresectable metastases from colon and rectal cancer, and, more recently, HAI has been shown to have utility for intrahepatic cholangiocarcinoma, improving survival for patients with both types of cancer. In some patients, surgeons can remove the tumors and place the chemotherapy pump to reduce recurrence rates.

Under the mentorship of Peter Allen, MD, now chief of surgical oncology at Duke, Lidsky received specialized HAI training while completing fellowships in surgical oncology and HPB surgery at Memorial Sloan Kettering Cancer Center (MSKCC). HAI was first introduced more than 50 years ago and has since been optimized by experts at MSKCC over the past four decades. Although the therapy has not been widely adopted, HAI is gaining momentum as an important therapy for many patients.

“Duke should be at the front of this effort so we can remain a leader in cancer care by providing cutting-edge multimodal therapies such as this one,” Lidsky says.

Cholangiocarcinoma is Lidsky’s research focus as well as one of his clinical interests. Patients with cholangiocarcinoma present therapeutic challenges because of the disease’s aggressive nature and high recurrence rates. Treatment options remain limited for this rare bile duct cancer; only 20% of patients are eligible for resection. Even among patients who undergo curative-intent resection followed by chemotherapy, the average life expectancy is only 4.5 years. For the remaining 80% of patients without a surgical option, chemotherapy is often the only treatment available, with survival averaging less than a year.

A significant dimension of Lidsky’s research at Duke is his cholangiocarcinoma research, which has two focus points:

• Using tumor samples taken during resection to create a growing library of preclinical models that help researchers learn more about the disease
• Deploying high-throughput functional genomics and precision pharmacology techniques to identify tumor-specific dependencies to discover novel therapeutics and/or augmentation strategies that may yield more effective treatments

“The exciting part for me is that I have the chance to be deeply involved in both the clinical and research dimensions in every aspect of my work,” says Lidsky, who completed his surgical residency at Duke. “The benefit of Duke is working in a highly collaborative environment where surgical oncologists, medical oncologists, radiation oncologists, interventional radiologists, and all of our support staff work together to identify therapeutic solutions. We customize a solution for every patient.”