Hepatic arterial infusion of chemotherapy for advanced hepatocellular carcinoma

Abstract

Treatment of advanced hepatocellular carcinoma (HCC) remains a significant problem for clinicians. Sorafenib, the only approved agent, improves survival rate, but is associated with a low tumor response rate. Alternative approaches for the treatment of advanced HCC are urgently needed. Hepatic arterial infusion of chemotherapy (HAIC) is a promising modality for the treatment of advanced HCC. Since its introduction, there have been improvements in implantable pumps, in catheter implantation and in the convenience and safety of HAIC in general. Numerous clinical studies have shown that HAIC provides moderate therapeutic efficacy with substantially favorable toxicity profiles in selected patient groups with advanced HCC. However, the lack of large randomized studies means that HAIC is not yet a well-established treatment for advanced HCC. We believe there is an urgent need for the further investigation of HAIC for the treatment of advanced HCC.

Hepatic arterial infusion chemotherapy in hepatocellular carcinoma with portal vein tumor thrombosis

“…In recent randomized controlled trials, sorafenib significantly increased patient survival [5,6] . However, contrary to our expectations, the survival and therapeutic advantages of sorafenib are modest, and the current cost of the drug precludes sorafenib from becoming a more generalized treatment tool for advanced HCC [7] . Systemic chemotherapy also has limited utility in treating HCC due to frequent toxicity and is not associated with improved survival [8,9] .…”

“…However, our study included patients with extrahepatic metastasis at the beginning of HAIC, whereas the previous studies excluded those patients. HAIC treatment is primarily used for the local control of liver tumors in patients with minimal extrahepatic spread [7] . Extrahepatic tumors would not respond well to HAIC.…”

“…First, we included patients with extrahepatic metastasis even though HAIC is only considered effective for the treatment of intrahepatic tumors [7] . However, extrahepatic metastasis was not independently associated with survival, and the results were as good as those of previous studies despite the inclusion of patients with extrahepatic metastasis.…”

Hepatic arterial infusion in hepatocellular carcinoma: a single center experience

“…A number of prospective trials and retrospective series have reported the results of HAI in Asian patients with hepatocellular carcinoma 8,9 . The efficacy and tolerance of HAI in Asian HCC patients has also been reviewed recently [10][11][12][13]29 . Despite the fact that different cytotoxic agents have been used across the spectrum of different primary tumors, 5-fluoro-2'-deoxyuridine (floxuridine) has been traditionally regarded as an optimal agent for HAI.…”

“…While chemoembolization, another liver-directed procedure targeting the vasculature, is a standard method in the management of patients with inoperable HCC based on the results of prospective trials indicating survival benefit 7 , the utilization of HAI in this setting is less frequent. Numerous studies on HAI in HCC have been reported from East Asia, especially from Japan [8][9][10][11][12][13][14][15][16][17][18][19][20] , but the experience with this approach in the Caucasian population of Western countries is very limited 21,22 . The use of HAI is currently not recommended in therapeutic guidelines, but this approach has been used in the past.…”