From the Guidelines
Hepatic artery infusions (HAI) should be considered a viable treatment option for patients with liver malignancies, particularly those with colorectal liver metastases or primary liver cancers, as it provides higher drug concentrations in liver tumors while reducing systemic toxicity 1.
Overview of HAI Therapy
HAI therapy involves delivering chemotherapy directly to the liver through a catheter placed in the hepatic artery. This approach is primarily used for colorectal liver metastases, primary liver cancers, and certain metastatic diseases confined to the liver. The most commonly used agents include floxuridine (FUDR), oxaliplatin, irinotecan, and mitomycin C.
Administration and Maintenance
Floxuridine (FUDR) is typically administered at 0.1-0.2 mg/kg/day via continuous infusion for 14 days in a 28-day cycle. Other medications, such as oxaliplatin (100 mg/m² over 2 hours every 2 weeks), irinotecan (180 mg/m² every 2-3 weeks), and mitomycin C (20-30 mg/m² every 4-8 weeks), may also be used. HAI therapy requires specialized surgical placement of a catheter connected to an implantable pump or port, followed by regular maintenance, including heparinized saline flushes to prevent occlusion.
Benefits and Complications
This approach provides higher drug concentrations in liver tumors while reducing systemic toxicity, as the liver metabolizes much of the drug before it reaches the systemic circulation. However, potential complications include catheter-related issues, chemical hepatitis, biliary sclerosis, and gastroduodenal ulceration, necessitating regular liver function monitoring.
- Key benefits of HAI therapy:
- Higher drug concentrations in liver tumors
- Reduced systemic toxicity
- Potential for improved outcomes when used in combination with systemic chemotherapy
- Key complications of HAI therapy:
- Catheter-related issues
- Chemical hepatitis
- Biliary sclerosis
- Gastroduodenal ulceration
Multidisciplinary Approach
HAI therapy is typically used in combination with systemic chemotherapy for optimal outcomes and should be managed by a multidisciplinary team experienced in this specialized treatment approach. As noted in a recent study, a multidisciplinary therapeutic strategy combining locoregional HAI treatment with sequential drug therapy may be an effective approach for advanced hepatocellular carcinoma 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION: ... The higher dosage ranges (0.4 to 0. 6 mg) are usually employed for hepatic artery infusion because the liver metabolizes the drug, thus reducing the potential for systemic toxicity.
- Hepatic artery infusions of floxuridine are typically administered at a higher dosage range of 0.4 to 0.6 mg/kg/day.
- This is because the liver metabolizes the drug, reducing the potential for systemic toxicity 2.
From the Research
Hepatic Artery Infusions
- Hepatic artery infusion (HAI) chemotherapy has been demonstrated to improve survival in patients with resected colorectal liver metastases (CRLM) and to facilitate conversion of technically unresectable disease 3.
- HAI in combination with systemic therapy can be utilized at multidisciplinary programs for patients with advanced CRLM, both in the adjuvant setting and to facilitate conversion of unresectable disease 3.
- The use of HAI chemotherapy in conjunction with systemic chemotherapy has been shown to augment response rates up to 92% in patients who are chemotherapy naive, and up to 85% in pretreated patients with initially unresectable CRLM 4.
Efficacy of Hepatic Artery Infusions
- Prospective trials have reported conversion to resectability (CTR) rates as high as 52% in heavily pretreated patients with initially unresectable CRLM who have an extensive hepatic disease burden 4.
- HAI in combination with systemic therapy leads to high response rates (85-90%) and conversion to resectability in primary unresectable disease in up to 50% of patients with CRLM 5.
- For hepatocellular carcinoma patients, response rates as high as 20-40% have been reported for HAI, and long-term outcomes compare well to other therapies 5.
Safety and Feasibility of Hepatic Artery Infusions
- Implementation of a new HAI program is safe and feasible with promising early oncologic outcomes 6, 7.
- Technical success and feasibility of HAI pump placement have been reported as 100% and 97%, respectively 6.
- HAI-specific complications, such as pump pocket seroma, hematoma, surgical-site infection, and extrahepatic perfusion, have been reported in a small percentage of patients 6, 7.