Hepatic Arterial Infusion Chemotherapy: Procedure, Benefits, Risks, Recovery and Alternatives

Hepatic Arterial Infusion Chemotherapy (HAIC) is a specialized, targeted cancer treatment designed for patients with liver tumors—either primary, such as hepatocellular carcinoma (HCC), or secondary, like colorectal cancer liver metastases (CRLM). As innovations in cancer therapy advance, HAIC stands out by delivering high concentrations of chemotherapy directly to liver tumors, potentially improving effectiveness and minimizing systemic side effects. This comprehensive guide will walk you through how the procedure works, its benefits, possible risks, recovery expectations, and alternative treatments—all grounded in the latest research.

Hepatic Arterial Infusion Chemotherapy: The Procedure

For patients and families exploring HAIC, understanding how the procedure works is essential. Unlike traditional systemic chemotherapy, which circulates throughout the body, HAIC delivers anticancer drugs directly into the liver via its arterial blood supply. This targeted approach allows higher local drug concentrations, maximizing tumor cell kill while attempting to reduce harm to the rest of the body.

Step	Description	Purpose	Source(s)
Catheterization	Insertion of catheter into hepatic artery	Direct drug delivery to liver	2, 5, 7
Pump Placement	Implantation of subcutaneous infusion pump	Continuous/controlled infusion	5, 7
Drug Infusion	Administration of chemotherapy (e.g., FOLFOX, floxuridine)	Attack liver tumors	4, 12
Monitoring	Imaging, labs, and follow-up	Assess response, manage complications	3, 5

Table 1: Key Procedure Steps in HAIC

Catheter and Pump Placement

• Catheterization involves the precise insertion of a catheter into the hepatic artery, typically performed by an interventional radiologist or a surgeon. The catheter is then connected to a subcutaneous infusion pump placed under the skin, usually in the abdomen or chest wall 5, 7.
• This pump allows for continuous or intermittent delivery of chemotherapeutic agents, optimizing exposure to liver tumors while minimizing systemic toxicity 5.

Choice of Chemotherapy Agents

• Common drugs include oxaliplatin, 5-fluorouracil, leucovorin (FOLFOX), floxuridine, cisplatin, raltitrexed, and, for HCC, sometimes combinations with targeted agents or immunotherapies 1, 8, 10, 12.
• Selection depends on tumor type, prior treatments, and patient condition 4, 12.

Treatment Sessions and Monitoring

• The infusion can be performed over several hours to days, with cycles repeated every few weeks 1, 3, 8.
• Throughout treatment, patients undergo regular imaging (CT/MRI) and blood tests to assess tumor response and monitor for complications such as catheter malfunction, infection, or liver dysfunction 3, 5.

Procedure Setting

• Initial catheter and pump placement generally require a hospital stay.
• Subsequent infusions may be delivered outpatient, with periodic pump refills and follow-up appointments 5, 7.

Benefits and Effectiveness of Hepatic Arterial Infusion Chemotherapy

HAIC offers hope for patients with advanced liver cancers, especially when surgery is not possible or prior systemic therapies have failed. By focusing chemotherapy directly on liver tumors, HAIC can improve response rates, survival, and sometimes even enable previously unresectable tumors to become operable.

Benefit	Effectiveness Data	Patient Population	Source(s)
Increased Response Rate	Up to 92% in chemo-naive, 85% in pretreated	Unresectable CRLM	4
Improved Survival	2-year survival 50–60% (vs 25–30% systemic)	Liver metastases	2, 7
Conversion to Resectability	Up to 52% in certain studies	Initially unresectable CRLM	4
Benefit in Advanced HCC	Median OS 9–17.9 months with HAIC	Advanced HCC	6, 8, 10, 14

Table 2: Summary of HAIC Benefits

Enhanced Tumor Response

• HAIC achieves higher drug concentrations in the liver, resulting in superior tumor response rates compared to systemic chemotherapy alone 2, 4.
• In patients with colorectal liver metastases, response rates can be as high as 92% in those not previously treated with chemotherapy 4.

Improved Survival Outcomes

• Studies consistently show HAIC can double two-year survival rates for patients with liver metastases (50–60%) compared to systemic chemotherapy alone (25–30%) 2.
• In hepatocellular carcinoma, HAIC extends survival compared to no active treatment and may be especially valuable when other locoregional therapies fail 6, 10, 11, 14.

Expanding Surgical Options

• HAIC can shrink liver tumors, allowing some patients with previously inoperable disease to undergo successful surgery. Conversion to resectability (CTR) rates reach up to 52% in certain heavily pretreated groups 4.
• Surgical removal after HAIC is associated with impressive survival outcomes—up to 80–85% two-year survival in selected patients 2, 3.

Multimodal Synergy

• Combining HAIC with systemic chemotherapy, targeted therapies, or immunotherapy enhances response and survival, especially in advanced cases 1, 8, 9, 14.

Risks and Side Effects of Hepatic Arterial Infusion Chemotherapy

While HAIC is generally well-tolerated, it is not without risks. Both the chemotherapy drugs and the delivery system carry potential complications, and side effects can range from mild to severe.

Risk/Side Effect	Frequency/Severity	Notes/Complications	Source(s)
Neutropenia	Up to 40% (Grade 3/4)	Risk of infection	1, 3, 9
Catheter/Pump Issues	Up to 31%	Infection, blockage, misplacement	3, 5, 7
Liver Toxicity	Mild to moderate	Elevated liver enzymes, jaundice	10, 12, 13
Abdominal Pain	Up to 43%	Usually related to infusion	9, 10
Other Chemo Side Effects	Nausea, diarrhea, hand-foot syndrome	Similar to systemic chemo	1, 9, 14

Table 3: Risks and Side Effects of HAIC

Chemotherapy Toxicities

• Blood cell suppression (neutropenia, thrombocytopenia, lymphopenia) is common and can lead to increased infection risk 1, 3, 9.
• Gastrointestinal side effects such as nausea, vomiting, diarrhea, and abdominal pain may occur, though sometimes less severe than with systemic chemotherapy 1, 9, 10.
• Liver toxicity, including elevated liver enzymes and, rarely, jaundice or acute hepatic dysfunction, can develop, especially in those with underlying liver disease 10, 12, 13.

Device-Related Complications

• Catheter or pump malfunction, infection, blockage, or accidental dislodgment can occur in up to a third of patients 3, 5, 7.
• Surgical-site complications (seroma, hematoma, infection) are also possible after pump placement 5.

Rare and Serious Risks

• Severe liver injury, sepsis, or chemotherapy overdose (if the pump malfunctions) are rare but serious possibilities.
• Treatment-related deaths are uncommon but have been reported 12.

Managing and Mitigating Risks

• Careful patient selection, meticulous technique, and close monitoring are critical for minimizing risk 5.
• Dose adjustments and supportive care (antibiotics, growth factors, antiemetics) are used to manage side effects 1, 9.

Recovery and Aftercare of Hepatic Arterial Infusion Chemotherapy

Recovery after HAIC involves both the immediate period following pump/catheter placement and the ongoing management required during and after chemotherapy infusions. Thoughtful aftercare is essential to maximize benefits and limit complications.

Phase	Key Actions	Patient Focus	Source(s)
Post-Procedure	Wound care, pain control	Prevent infection, ensure healing	5, 7
During Chemotherapy	Monitoring labs and imaging	Track response, side effects	3, 5
Ongoing Aftercare	Pump maintenance, managing side effects	Quality of life, complication prevention	1, 13
Long-Term Follow-Up	Assess liver function, disease status	Early detection of recurrence or late effects	3, 10, 13

Table 4: Recovery and Aftercare Steps

Immediate Post-Procedure Phase

• After surgical or interventional placement of the pump/catheter, patients typically stay in the hospital for observation and wound care.
• Pain management, prevention of infection, and ensuring the device functions properly are top priorities 5, 7.

Chemotherapy Infusion Period

• Patients return for scheduled infusions, during which liver function, blood counts, and overall health are closely monitored 3, 5.
• Imaging studies (CT/MRI) are performed periodically to assess tumor response 3.

Managing Side Effects

• Supportive medications (antiemetics, pain relievers, growth factors) may be prescribed.
• Patients are educated on signs of infection, pump/catheter issues, and when to seek urgent care 1, 5.

Ongoing and Long-term Follow-Up

• Routine visits for pump maintenance/refills are necessary.
• Long-term follow-up focuses on monitoring for cancer recurrence, liver function, and late complications 3, 10, 13.

Quality of Life Considerations

• Studies show that, although quality of life can transiently deteriorate during the first few treatment cycles, most patients recover to baseline levels after several cycles 1.
• Preserving liver function is a key goal, particularly in those with underlying cirrhosis or compromised liver reserve 13.

Alternatives of Hepatic Arterial Infusion Chemotherapy

While HAIC is an important option for some patients, it is not suitable for everyone. Several alternatives exist, each with their own strengths and limitations, and the best choice depends on tumor type, stage, liver function, and prior therapies.

Alternative	When Used	Pros/Cons	Source(s)
Systemic Chemotherapy	First-line for many metastatic cancers	Broadly available, systemic toxicity	2, 3, 4
Transarterial Chemoembolization (TACE)	Intermediate-stage HCC	Locoregional, not for advanced disease	10, 13
Targeted Therapy (e.g., sorafenib, lenvatinib)	Advanced HCC, failed locoregional therapy	Oral agents, systemic side effects	11, 14
Immunotherapy	Advanced/refractory HCC	Durable responses in some, immune side effects	1, 8
Surgical Resection	Resectable liver tumors	Potential cure, not always feasible	2, 3, 4, 7
Ablation	Small, limited liver tumors	Minimally invasive, size/location-limited	3, 9

Table 5: Alternatives to HAIC

Systemic Chemotherapy

• Remains the standard of care for many liver metastases (especially from colorectal cancer), but has lower response rates and more widespread side effects compared to HAIC 2, 4.
• May be combined with HAIC, especially for liver-dominant disease 4, 9.

Transarterial Chemoembolization (TACE)

• Delivers chemotherapy and blocks blood flow to tumors, mainly used for intermediate-stage HCC.
• Not suitable for very advanced disease or those with poor liver function 10, 13.

Targeted Therapy and Immunotherapy

• Drugs like sorafenib, lenvatinib, and newer immunotherapies (PD-1 inhibitors) are used in advanced HCC, often after locoregional therapies fail 1, 8, 11, 14.
• Combination strategies (e.g., HAIC plus sorafenib or immunotherapy) are under investigation and may enhance outcomes 1, 8, 14.

Surgical Resection and Ablation

• Offer the best chance for cure when feasible.
• HAIC can sometimes shrink tumors to allow surgery or ablation in previously inoperable patients 2, 4, 7, 9.

Choosing the Right Approach

• Treatment decisions are highly individualized, guided by tumor type, extent, prior treatments, and patient health.
• Multidisciplinary consultation is recommended for optimal results 5.

Conclusion

Hepatic Arterial Infusion Chemotherapy is a sophisticated, targeted therapy that delivers promising results for challenging liver cancers. By understanding its procedure, benefits, risks, recovery, and alternatives, patients and families can make informed decisions in partnership with their medical team.

Key Takeaways:

• HAIC delivers chemotherapy directly to liver tumors, maximizing local effect while limiting systemic toxicity 2, 4.
• Benefits include higher response rates, improved survival, and potential conversion to surgery in select patients 2, 3, 4, 7.
• Risks include blood cell suppression, device-related complications, and liver toxicity, but these are generally manageable with proper care 1, 3, 5, 9, 10.
• Recovery involves attentive monitoring, device maintenance, and supportive care, with most patients able to maintain or regain quality of life 1, 5, 13.
• Alternatives include systemic therapies, TACE, targeted and immune therapies, and surgery or ablation, with treatment tailored to individual needs 2, 3, 4, 7, 9, 10, 11, 13, 14.

If you or a loved one is facing a diagnosis of liver cancer or liver metastases, consulting with a multidisciplinary team experienced in HAIC and other liver-directed therapies can help identify the most effective and personalized treatment plan.