Efficacy of Hepatic Arterial Infusion Chemotherapy (HAIC) for Advanced Hepatocellular Carcinoma

As per the latest data of the International Agency for Research on Cancer, more than 8 million individuals die annually owing to the exacerbation of a given neoplasm, and the total number of annual deaths due to hepatocellular carcinoma (HCC) is 0.78 million, the second-highest of all cancer-related deaths. HCC has a very poor prognosis, reflected by the fact that the incidence-to-mortality ratio of HCC has been estimated to be more than 90%. Liver cancer is generally diagnosed only in the advanced clinical stage because HCC tends to be clinically silent during the early stages. With regard to HCC management, transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC), as well as molecularly targeted agents such as sorafenib and lenvatinib, have shown promising benefits for advanced HCC. However, even though the Barcelona Clinic Liver Cancer staging system has been widely accepted, controversies still exist regarding the best choice for the management of HCC in individual cases. In this chapter, we infer that HAIC treatment is not inferior to molecularly targeted therapies for the treatment of advanced HCC—particularly in case of intravascular invasion in both compensated and decompensated cirrhotic patients. Furthermore, the rate of adverse events leading to discontinuation of antitumor treatment appears relatively low. Given the hepatic function reserve preservation afforded by HAIC chemotherapy, we suggest that HAIC should be considered as an alternative strategy even for advanced-HCC patients with decompensated cirrhosis, who do not respond to TACE.

Keywords: 5-fluorouracil, Advanced stage, Chemotherapy, Child–Pugh classification, Cisplatin, Hepatic arterial infusion, Hepatic functional reserve, Hepatocellular carcinoma, Lenvatinib, Molecularly targeted therapies, Overall survival, Portal invasion, Progression-free survival, Reservoir, Sorafenib.