Toxicity and efficacy of hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma (Review)

Abstract

Abstract. The prognosis of advanced hepatocellular carcinoma (HCC) remains poor, particularly for patients with portal vein tumor thrombosis. Chemotherapy is one of the most significant treatment options for patients with advanced HCC not indicated for hepatic resection, percutaneous ablation and transcatheter arterial chemoembolization. Systemic chemotherapy does not play a central role in the treatment of HCC due to the issue of low sensitivity for chemotherapeutic agents and the difficulties in administering a sufficient dose due to chronic liver dysfunction. Therefore, patients with advanced HCC are usually treated with hepatic arterial infusion chemotherapy (HAIC), which is increasingly used as an approach to advanced HCC in Japan. HAIC provides moderate therapeutic efficacy and survival benefit with substantially tolerable toxicity profiles in patients with advanced HCC.

Current management of hepatocellular carcinoma: An Eastern perspective

“…HAIC does not use embolic material, and the chemotherapeutic agent is infused into the hepatic artery via an implanted catheter, which reduces systemic side effects by firstpass effects and maximizes drug delivery to the tumor. Although this is considered an experimental treatment modality and is not recommended for treatment of HCC in Western countries, a large amount of clinical data on HAIC have been accumulated in Eastern countries [67][68][69][70][71][72] . A small retrospective study showed survival benefits of HAIC using low doses of cisplatin and 5-fluorouracil compared with systemic cytotoxic chemotherapy or supportive care (median survival, 6, 4, and 2 mo, respectively; P = 0.003) in cases of advanced HCC with portal vein tumor thrombosis [73] .…”

“…Hepatic arterial infusion chemotherapy (HAIC) has been used for treatment of advanced HCC with portal vein tumor thrombosis in Asian countries [67][68][69][70][71][72] . Traditionally, the presence of tumor thrombus is assumed to aggravate ischemic injuries after TACE, so alternative modalities were sought.…”

A novel cell cycle blocker extracted from Stellera chamaejasme L. inhibits the proliferation of hepatocarcinoma cells

“…Moreover, the commonly used chemical agents usually have unexpected side-effects, such as hair loss, nausea, vomiting, and diarrhea (31). Additionally, after resection or transarterial chemoembolization, the impaired physiological function of the liver and gallbladder leads to further severe side-effects and systemic toxicity (32).…”

Hepatic arterial infusion in hepatocellular carcinoma: a single center experience

“…A number of prospective trials and retrospective series have reported the results of HAI in Asian patients with hepatocellular carcinoma 8,9 . The efficacy and tolerance of HAI in Asian HCC patients has also been reviewed recently [10][11][12][13]29 . Despite the fact that different cytotoxic agents have been used across the spectrum of different primary tumors, 5-fluoro-2'-deoxyuridine (floxuridine) has been traditionally regarded as an optimal agent for HAI.…”

“…While chemoembolization, another liver-directed procedure targeting the vasculature, is a standard method in the management of patients with inoperable HCC based on the results of prospective trials indicating survival benefit 7 , the utilization of HAI in this setting is less frequent. Numerous studies on HAI in HCC have been reported from East Asia, especially from Japan [8][9][10][11][12][13][14][15][16][17][18][19][20] , but the experience with this approach in the Caucasian population of Western countries is very limited 21,22 . The use of HAI is currently not recommended in therapeutic guidelines, but this approach has been used in the past.…”