Intra-arterial infusion via Intera 3000 hepatic artery infusion (HAI) pump Formulary Restrictions:

• Indication: Unresectable intrahepatic cholangiocarcinoma; unresectable and resectable intrahepatic metastases of colorectal cancer
• Service line: Surgical Oncology/Medical Oncology
• Formulary location: Inpatient (pump placement), outpatient (floxuridine and pump refills)
• Service location: Procedural area (inpatient), outpatient infusion
• Patient population: Adults
• Prior authorization required: Yes for outpatient
• Restriction/criteria of use (all will apply unless specified):
  • Histologically confirmed intrahepatic cholangiocarcinoma or intrahepatic metastases of colorectal cancer
  • Fit to undergo a major abdominal operation (Eastern Cooperative Oncology Group (ECOG) 0-1)
  • No clinical, laboratory, or radiographic evidence of portal hypertension or portal vein thrombosis
  • Preserved hepatic function, total bilirubin < 1.5 mg/dL
  • Favorable hepatic anatomy (patent gastroduodenal artery with adequate length and caliber)
  • Any patient that has had a liver resection who has preserved hepatic function
  • Restrict location to centers/providers with manufacturer provided training

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