Name of the Procedure:

Injection, Irinotecan Liposome, 1 mg (HCPCS Code: J9205)

Summary

Irinotecan liposome injection is a medical treatment used to deliver chemotherapy directly into the bloodstream. It targets and destroys cancer cells, specifically formulated to improve the delivery and effectiveness of the chemotherapy drug irinotecan.

Purpose

Medical Conditions

This procedure primarily addresses:

• Pancreatic cancer
• Other cancers for which irinotecan has been deemed effective

Goals

• To reduce the size of cancerous tumors
• To slow the spread of cancer
• To alleviate symptoms associated with cancer

Indications

Symptoms or Conditions

• Diagnosed pancreatic cancer
• Other cancers responsive to irinotecan treatment

Patient Criteria

• Patients who have not responded adequately to other chemotherapy treatments
• Patients with a sufficient performance status to tolerate chemotherapy

Preparation

Pre-procedure Instructions

• Fast for a specified period, usually 6-8 hours before the procedure
• Inform your doctor about any medications you are taking, as some may need to be paused

Diagnostic Tests

• Blood tests to assess liver and kidney function
• Complete blood count (CBC)
• Imaging studies, if necessary, to evaluate the extent of cancer

Procedure Description

1. Preparation:

   • The patient is positioned comfortably in a treatment chair or bed.
   • An intravenous (IV) line is established for medication administration.

2. Administration:

   • Irinotecan liposome is administered slowly via the IV line over a specified period, usually 90 minutes.

3. Monitoring:

   • Vital signs are continuously monitored throughout the procedure.
   • The patient is observed for any immediate adverse reactions.

Tools and Equipment

• IV line
• Infusion pump
• Monitoring equipment for vitals

Anesthesia

• Generally, no anesthesia or sedation is required for this procedure.

Duration

• The infusion of irinotecan liposome typically takes about 90 minutes.
• The total appointment time could be around 2-3 hours to account for preparation and monitoring.

Setting

• Typically performed in an outpatient clinic or hospital chemotherapy unit.

Personnel

• Oncologist
• Chemotherapy nurse
• Monitoring staff (e.g., medical assistants)

Risks and Complications

Common Risks

• Nausea and vomiting
• Diarrhea
• Fatigue
• Low blood cell counts (neutropenia, anemia, thrombocytopenia)

Rare Risks

• Severe allergic reactions
• Severe dehydration due to diarrhea
• Infection due to low white blood cell counts

Management

• Anti-nausea medications
• Hydration therapy
• Close monitoring and supportive care

Benefits

Expected Benefits

• Reduction in tumor size
• Decrease in the spread of cancer cells
• Symptom relief

Realization Time

• Improvement can vary; benefits might be seen within a few weeks, but the full effect might take several months.

Recovery

Post-procedure Care

• Hydration is crucial; drink plenty of fluids.
• Take anti-nausea and anti-diarrheal medications as prescribed.
• Monitor for signs of infections or other side effects.

Expected Recovery Time

• Recovery can vary; some side effects like fatigue may persist for weeks.
• Regular follow-up visits will be scheduled to monitor progress.

Restrictions

• Limited physical activity based on how the patient feels.
• Avoiding exposure to infections due to lowered immunity.

Alternatives

Other Treatment Options

• Other chemotherapy regimens
• Radiation therapy
• Surgical options (if applicable)
• Clinical trials for new treatments

Pros and Cons

• Other Chemotherapy: May be less effective but have varying side effects.
• Radiation: Targets specific areas but may not be suitable for widespread cancer.
• Surgery: Potentially curative but not always possible.
• Clinical Trials: Access to new treatments but with unknown efficacy/safety.

Patient Experience

During the Procedure

• Patient may feel slight discomfort from the IV insertion.
• Generally, the patient will sit or lie comfortably during the infusion.

After the Procedure

• Fatigue, nausea, and mild discomfort are common and managed with medications.
• Pain management and comfort measures include rest, hydration, and prescribed medications to handle side effects.