Cancer Network: Are there other possible alternative pumps that could perform a similar function for patients with liver metastases? Or is this really a singular type of device?
Dr. Kemeny: There is another [one], called the Medtronic pump, and it’s approved for giving pain medicine and not really used for hepatic treatment. But it’s a similar type of continuous-infusion pump that’s similar to the Codman pump we use. The only difference with the Medtronic pump is that it has to be programmed using a computer.
You need to put in a computer hand device over the pump and program it to work. In contrast, the Codman pump just needs to be filled, and it works without any programming. So, that is a problem for patients. For us here at Memorial Sloan Kettering, I can teach our nurses how to do it. We can have a computer here and can do it, but right now I have patients from all over the country who are asking their doctors to empty the pump because that helps the patient. They come here to get the pump initially, but then their local doctor can help with emptying the pump.
Now I have to tell these doctors that they need to program this pump, and many of them may not want to do that. It’s a more complicated [procedure] thing and they may not want to be responsible for it.
This is where we are right now. There are also pumps in Europe but they are not approved by the US Food and Drug Administration [FDA]. For some of these small companies outside the US, receiving an FDA approval will cost them a lot of money, so some of them don’t want to enter the US market. But what is not clear to me is why a pump that was working great here, why we can’t have this, why can’t someone else make it if this company no longer wants to? It is approved by the FDA and it works!
Cancer Network: Is there a more recent update on the catheters that you could connect to the Medtronic pump?
Dr. Kemeny: More recently, the company, Cerenovus, [was] telling me that they can give [the catheters] to me, and so I have catheters to connect to the Medtronic pump. But when they first told me this, they literally were closing my program and everyone else’s because they told us that we were getting neither the catheters nor the pumps. Now, with the catheters, we are not closed down, but we do have problems. [At least] for the patients, there is an alternative for now.
Cancer Network: How rare is this type of event where a vital drug or device for cancer patients is taken off the market? Have you had a similar experience previously?
Dr. Kemeny: There are not that many devices, so you see this [happen] more with drugs. The first experience I had like this was the drug we use, FUDR. Remember [that] I mentioned this CALGB study.
During that study, the company that made the drug, Roche, said that they wouldn’t make it anymore, we are not making any money from it. And the reason they weren’t making any money from it is that it was a very cheap drug. But, fortunately, I was able to get a pharmacy to make it so I didn’t lose the drug or the trial. It’s still a very cheap drug compared to many newer drugs. And that is the problem with the pump, it is cheap. You put it in and can last for years so the patient is not, in a sense, [paying] a lot for the treatment.