New tools treat complex, late-stage cancers in targeted ways
Fact checked by Jim Lacy
When Dave Tolchin, then 39, began experiencing abdominal pain in 2024, he thought he had diverticulitis. As his symptoms worsened, he visited the emergency room, where a CT scan confirmed the condition and showed a perforation in his colon.
His medical team operated to repair his colon and discovered something else: stage 4 colon cancer. Soon after, Tolchin started chemotherapy.
“The systemic [chemotherapy] worked really well,” says the now 41-year-old from Wood Dale, Illinois.
Yet two tumors remained in his liver. Doctors didn’t believe additional systemic chemotherapy would shrink them, and surgeons couldn’t remove them. But Tolchin’s surgical oncologist, George Salti, MD, at Endeavor Health, suggested another option.
Tolchin recalls Salti telling him about a liver pump. “‘You might be a great candidate,’” he remembers Salti saying.
In October 2024, Tolchin received a hepatic artery infusion (HAI) pump, which “targets cancer in the liver and only in the liver,” Salti says. It is a newer chemotherapy option for some patients with colorectal cancer that has metastasized to the liver or for certain patients with unresectable cholangiocarcinoma, a rare bile duct cancer. Physicians use the pump to treat tumors that surgeons cannot remove, Salti says.
“It basically allows a higher dose of chemotherapy to be delivered into the liver,” he says. “[The chemotherapy] doesn’t come out of the liver, and it should not cause systemic side effects like regular chemotherapy.”
During surgery, doctors place a port into the hepatic artery and insert the pump under the skin.
“It’s a kind of reservoir that we put the treatment into,” says Evan Pisick, MD, a medical oncologist at City of Hope Cancer Center Chicago. “It slowly infuses into the liver over two weeks.”
People with an HAI pump receive chemotherapy for two weeks and then a nonchemotherapy solution for two weeks throughout the duration of treatment, Pisick says. While HAI pumps are becoming more widely available, they’re still mostly offered at cancer centers. Surgeons must undergo training to learn how to insert the pump into the hepatic artery. In the Chicago area, City of Hope, Endeavor Health, and UChicago Medicine offer HAI pumps.
“It basically allows a higher dose of chemotherapy to be delivered into the liver.”
People with stage 4 colorectal cancer that has metastasized to the lymph nodes, lungs, or bones don’t qualify for an HAI pump.
“You don’t want to do it just for the sake of doing it if you’re not going to provide a potential benefit,” Pisick says.
By April 2025, Tolchin’s two liver metastases “basically disappeared,” Tolchin says, adding, “It got rid of those two tumors. I was absolutely thrilled.”
Thanks to the HAI pump, he could pause active treatment. Now, Tolchin undergoes regular scans and bloodwork to ensure his health remains stable.
Targeting the abdomen
Another recent development in chemotherapy is helping some patients with cancer in their abdominal cavity. Vicky Strider is one of them. In 2025, doctors diagnosed her with stage 4 appendiceal cancer, an extremely rare disease. She says her doctor “sent [her] home to die.”
“He wasn’t going to do anything, no further treatment,” Strider, 66, says. “My daughter couldn’t handle that.”
Strider’s daughter joined an appendiceal cancer support group online, where she learned about pressurized intraperitoneal aerosol chemotherapy (PIPAC). Physicians use this novel therapy to treat ovarian, colorectal, and appendiceal cancers. Through minimally invasive surgery, they aerosolize the chemotherapy for 30 minutes in the abdominal cavity, Salti says.
“It’s more palliative than curative, with the hope to slow the cancer progression and maybe help symptom relief,” Salti says. Sometimes, the tumor shrinks enough to make surgery possible.
Recent clinical trials are investigating whether PIPAC will work for patients with gastric and esophageal cancers that have metastasized to the abdominal cavity, Pisick says. Currently, PIPAC can be used only in ovarian, colorectal, and appendiceal cancers that haven’t spread outside the abdominal cavity.
“If you have cancer outside the abdominal cavity or in the lymph nodes or inside the liver, then these treatments don’t work,” Pisick says. “You can’t get [the chemotherapy] into those areas.”
Fewer cancer centers offer PIPAC than HAI pumps. Strider travels from Moore County, North Carolina, to undergo treatment at Endeavor Health. While Endeavor and UChicago Medicine currently offer PIPAC in the Chicago area, City of Hope plans to offer it in the near future.
Strider has undergone PIPAC three times, with a fourth treatment planned. After that, Salti will determine whether the treatment is still slowing her cancer’s growth.
“[Salti] was pleased at the progress between treatment number two and treatment number three,” Strider says. “It had made such wonderful progress.”
PIPAC treatments made Strider feel well enough to join her daughter and grandchildren at Disney. Recovery involves staying afew extra days in Chicago to ensure she doesn’t have complications. Still, she doesn’t mind the travel.
“I would highly recommend it if people want the quality time [with their loved ones],” she says.
