Haic Chemotherapy: Procedure, Benefits, Risks, Recovery and Alternatives

Hepatic arterial infusion chemotherapy (HAIC) is fast emerging as a powerful, targeted treatment option for patients battling advanced or inoperable liver cancers, including hepatocellular carcinoma (HCC) and metastatic colorectal cancer. By delivering chemotherapy directly into the liver’s blood supply, HAIC offers hope where other strategies may fall short. In this comprehensive guide, we’ll walk you through the HAIC procedure, its benefits and effectiveness, potential risks, recovery expectations, and alternative treatments—helping you and your loved ones make informed, confident decisions.

Haic Chemotherapy: The Procedure

HAIC stands apart from standard chemotherapy because it targets tumors in the liver with high concentrations of anti-cancer drugs, while minimizing systemic side effects. The process involves specialized radiological techniques and close teamwork between oncologists, interventional radiologists, and nursing staff.

Step	Description	Purpose	Sources
Access	Catheter inserted into hepatic artery	Direct drug delivery to liver	3 5
Drug Infusion	Chemotherapy (e.g., FOLFOX, floxuridine) administered via pump or infusion	High local drug concentration	1 4 5
Duration	Sessions last hours to days, repeated in cycles	Ongoing tumor suppression	1 3 13
Setting	Outpatient or short hospital stay	Patient comfort & safety	3 13

Table 1: Key Steps in the HAIC Procedure

How HAIC Is Performed

HAIC begins with the placement of a thin catheter directly into the hepatic artery—the main vessel supplying blood to the liver. This is typically done percutaneously (through the skin) by an interventional radiologist, using image guidance. In some cases, a surgical approach is used to implant a port with a subcutaneous pump for repeated treatments 3 5.

Chemotherapy Delivery

Once the catheter is in place, chemotherapy drugs (commonly FOLFOX, floxuridine, or raltitrexed) are infused directly into the liver, often over several hours or even days, depending on the regimen. This targeted approach ensures the tumor receives a much higher concentration of the drug compared to standard intravenous chemotherapy, while reducing exposure to the rest of the body 1 4 5.

Treatment Setting and Cycles

HAIC may be performed in an outpatient setting or require a short hospital stay, particularly for patients receiving continuous infusions or those with more complex care needs. Treatment usually follows a cycle—often every two to three weeks—allowing time for the body to recover between sessions 1 3 13.

Benefits and Effectiveness of Haic Chemotherapy

HAIC’s primary appeal lies in its ability to achieve high local tumor control with fewer side effects than traditional chemotherapy. Recent studies show it can significantly improve survival and response rates, especially for patients with advanced or inoperable liver cancers.

Benefit	Outcome	Patient Group	Sources
Survival	Improved overall survival (OS)	Unresectable HCC, CRLM	1 5 6 8
Tumor Response	Higher response & control rates	HCC, CRLM	1 4 11
Resectability	Increased chance of surgery	Colorectal liver metastases	4 5
Combinations	Enhanced results with systemic or immunotherapy	Advanced HCC	7 9 10 12 14

Table 2: Main Benefits and Effectiveness Outcomes of HAIC

Boosted Survival and Tumor Control

• Unresectable Hepatocellular Carcinoma (HCC): HAIC with FOLFOX nearly doubled median overall survival compared to TACE (23.1 vs. 16.1 months) 1. Meta-analyses confirm HAIC prolongs both OS and progression-free survival (PFS) in advanced HCC 6 8 11.
• Colorectal Liver Metastases (CRLM): Patients treated with HAIC (especially with floxuridine) after liver surgery saw significant survival gains over those without HAIC 5.

Higher Response Rates

HAIC consistently outperforms standard systemic treatments for tumor shrinkage and disease control rates:

• Objective response rates up to 46% for large HCC 1, and up to 92% when combined with systemic chemotherapy in colorectal liver metastases 4.
• In advanced HCC, adding anti-angiogenic agents or immune checkpoint inhibitors to HAIC boosts response and survival even further 7 9 10 12 14.

Conversion to Surgery

One of HAIC’s most exciting potentials is converting previously inoperable tumors into candidates for surgical resection, offering a chance for cure:

• Conversion-to-resectability rates reach as high as 52% in some colorectal liver metastasis studies 4.

Synergy with Other Treatments

• Combining HAIC with targeted therapies (like lenvatinib or apatinib) and immunotherapies (PD-1 inhibitors) achieves even greater tumor control and survival, albeit with increased—but manageable—side effects 7 9 10 12 14.

Risks and Side Effects of Haic Chemotherapy

While HAIC is generally well-tolerated, it does carry specific risks and side effects. Understanding these helps patients and families prepare and make informed choices.

Risk	Description	Frequency/Severity	Sources
Liver Toxicity	Hepatic dysfunction, elevated enzymes	Mild to severe, occasionally serious	2 11 13 14
Blood Effects	Thrombocytopenia, leukopenia, anemia	Common but manageable	2 10 13 14
Infection	Due to catheter or immunosuppression	Low to moderate risk	13 14
GI Symptoms	Nausea, vomiting, abdominal pain	Usually mild to moderate	11 14 16

Table 3: Common Risks and Side Effects of HAIC

Liver-Related Side Effects

Since HAIC delivers high doses of chemotherapy directly into the liver, some degree of liver irritation or toxicity is expected. Most patients experience mild, transient increases in liver enzymes, but a minority may develop more serious hepatic dysfunction, especially with repeated cycles or pre-existing liver disease 2 11 13 14.

Blood Cell Changes

• Thrombocytopenia, leukopenia, and anemia can occur, but are generally manageable with dose adjustments or supportive care. Severe cases are less common but are closely monitored 2 10 13 14.
• In studies, grade 3 or higher drops in lymphocyte or neutrophil counts occurred in up to 37% of patients, but rarely led to life-threatening events 10 14.

Infection and Catheter Complications

Any implanted catheter carries a risk of infection or blockage. Good hygiene, regular maintenance, and prompt attention to symptoms help minimize these risks 13 14.

Gastrointestinal and Other Symptoms

Nausea, vomiting, and abdominal pain are reported, but are usually milder than with systemic chemotherapy. Fatigue and mild pain at the catheter site are also possible 11 14 16.

Serious Adverse Events

Serious side effects (requiring hospitalization or causing death) are rare, occurring in less than 5% of patients in most studies. Side effects are generally more frequent with combination regimens but remain tolerable and manageable 1 2 14.

Recovery and Aftercare of Haic Chemotherapy

Recovery from HAIC is often quicker than with systemic chemotherapy, thanks to the targeted nature of treatment. However, patients benefit from structured aftercare to maximize outcomes and minimize complications.

Recovery Aspect	What to Expect	Patient Tips/Needs	Sources
Hospital Stay	Outpatient or short admission	Rest, monitoring	3 13
Catheter Care	Regular flushing, infection watch	Hygiene, nurse input	3 13 14
Blood Tests	Monitor liver & blood counts	Frequent checks early	2 11 13
Side Effect Mngmt	Supportive meds, dose changes	Report symptoms early	10 14

Table 4: Recovery and Aftercare Essentials for HAIC

Immediate Recovery

• Most HAIC sessions require observation for a few hours to overnight.
• Patients are monitored for pain, bleeding, or allergic reactions, and vital signs are closely tracked 3 13.

Catheter and Port Maintenance

• Ports/catheters require regular flushing and dressing changes to prevent infection or blockage.
• Patients and caregivers are taught how to care for the access site at home, and are advised to report any redness, swelling, or fever immediately 3 13 14.

Monitoring for Side Effects

• Regular blood work tracks liver function and blood cell counts, especially during the first few cycles.
• Supportive medications (anti-nausea, pain relievers) are provided as needed 2 10 13 14.

Long-Term Follow-Up

• Imaging studies (CT/MRI) are performed periodically to assess tumor response.
• Discussions about next steps—additional cycles, surgery, or alternative therapies—are ongoing and tailored to each patient’s progress 4 5 13.

Alternatives of Haic Chemotherapy

HAIC is a preferred option for certain patients, but several alternatives exist depending on cancer type, stage, and overall health. Understanding these enables shared decision-making.

Alternative	Key Features	Main Advantages	Sources
Systemic Chemotherapy	IV administration, body-wide	Treats extrahepatic disease	2 4 5
TACE	Chemo + embolization	Local control, widely used	1 13
Targeted Therapy	e.g., Sorafenib, Lenvatinib	Oral, for advanced HCC	7 16 17
Immunotherapy	PD-1/PD-L1 inhibitors	Effective in combo regimens	7 9 10 12 14

Table 5: Main Alternatives to HAIC

Systemic Chemotherapy

Still the backbone for metastatic colorectal cancer and some advanced HCC, systemic chemotherapy treats cancer throughout the body but often with more severe side effects and lower liver tumor response rates compared to HAIC 2 4 5.

Transarterial Chemoembolization (TACE)

TACE combines arterial delivery of chemotherapy with embolic particles to block blood flow, starving tumors. It’s a mainstay for intermediate-stage HCC, but HAIC has shown longer survival and fewer serious adverse events in some head-to-head trials 1 13.

Targeted Therapies

Oral drugs like sorafenib and lenvatinib block tumor growth signals and blood vessel formation. While convenient, they can cause more systemic side effects like hypertension and skin issues. HAIC has demonstrated better tumor response and survival rates in several studies for advanced HCC 7 16 17.

Immunotherapies and Combination Strategies

• PD-1/PD-L1 inhibitors (e.g., camrelizumab, toripalimab, tislelizumab) are increasingly combined with HAIC and targeted agents, achieving unprecedented response and survival rates in high-risk and advanced HCC.
• These combinations are associated with more side effects, but most are manageable 7 9 10 12 14.

When to Consider Alternatives

• Patients with widespread disease outside the liver, poor liver function, or previous intolerance to HAIC may benefit more from systemic or immunotherapy options.
• The choice should always be personalized, weighing the potential for tumor control against the side effect profile and patient preference.

Conclusion

HAIC chemotherapy is reshaping the landscape of liver cancer care, offering hope to patients who previously had limited options. Here’s what we’ve learned:

• HAIC delivers high-dose chemotherapy directly to liver tumors, improving local control and reducing systemic toxicity 1 3 4.
• It significantly improves survival and tumor response rates, especially in unresectable HCC and colorectal liver metastases 1 5 6 8 11.
• Side effects are generally manageable, with liver toxicity and blood cell changes being the most common risks 2 10 13 14.
• Recovery tends to be quicker than with systemic chemotherapy, but catheter care and close monitoring are essential 3 13.
• Alternatives like TACE, systemic chemotherapy, targeted agents, and immunotherapies are available and may be preferable in certain scenarios 1 2 4 5 7 16 17.
• Combination regimens with immunotherapy and targeted therapy are pushing survival rates even higher, at the cost of more (but usually manageable) side effects 7 9 10 12 14.

Discussing these options with your oncology team ensures your treatment is tailored to your needs and goals—empowering you to navigate your cancer journey with confidence.