Revisiting Hepatic Artery Infusion Chemotherapy in the Treatment of Advanced Hepatocellular Carcinoma

Abstract

Hepatic artery infusion chemotherapy (HAIC) is a well-established and common treatment for advanced hepatocellular carcinoma (HCC), particularly in East Asia. However, HAIC is not recognized internationally. Although several trials have demonstrated the safety and efficacy of HAIC, evidence corroborating its overall survival (OS) benefits compared with standard treatments is insufficient. Nevertheless, HAIC may provide prominent benefits in selected patients such as patients with portal vein thrombosis or high intrahepatic tumor burden. Moreover, HAIC has been combined with several therapeutic agents and modalities, including interferon-alpha, multikinase inhibitors, radiation therapy, and immunotherapy, to augment its treatment efficacy. Most of these combinations appeared to increase overall response rates compared with HAIC alone, but results regarding OS are inconclusive. Two prospective randomized controlled trials comparing HAIC plus sorafenib with sorafenib alone have reported conflicting results, necessitating further research. As immunotherapy-based combinations became the mainstream treatments for advanced HCC, HAIC plus immunotherapy-based treatments also showed encouraging preliminary results. The trials of HAIC were heterogeneous in terms of patient selection, chemotherapy regimens and doses, HAIC combination agent selections, and HAIC technical protocols. These heterogeneities may contribute to differences in treatment efficacy, thus increasing the difficulty of interpreting trial results. We propose that future trials of HAIC standardize these key factors to reveal the clinical value of HAIC-based treatments for HCC.

Locoregional therapies for hepatocellular carcinoma: The current status and future perspectives

“…The paradoxical results of the two studies regarding the effects of the first‐line HAIC combination need further exploration. There were differences in several aspects, including HCC populations, aetiology, chemotherapeutic drug regimens, and procedure techniques, that may have an impact 80 …”

Network pharmacology analysis and experimental verification of the antitumor effect and molecular mechanism of isocryptomerin on HepG2 cells

“…Treatment with chemotherapy drugs can prolong the survival time of patients, which gives patients higher chances of survival. Still, chemotherapy drugs have strong toxicity and side effects (Chen, Liu, et al, 2021; Pan et al, 2021). Therefore, it is urgent to find natural drugs with good therapeutic effects, low toxicity, and limited side effects.…”

Hepatic arterial infusion chemotherapy in hepatocellular carcinoma: A bibliometric and knowledge-map analysis

“…First, HAIC delivers a high concentration of drugs continuously to the tumor through arteries in it, avoiding the "first-pass effect." In addition, HAIC can kill tumors while reducing systemic side effects (9)(10)(11).…”

“…As a form of local chemotherapy, HAIC has several advantages over systemic intravenous chemotherapy ( 7 , 8 ). First, HAIC delivers a high concentration of drugs continuously to the tumor through arteries in it, avoiding the “first-pass effect.” In addition, HAIC can kill tumors while reducing systemic side effects ( 9 – 11 ).…”