| Abstract: |
Liver metastases as well as primary liver tumors derive their blood supply predominantly from the hepatic artery rather than the portal vein. Sustained high levels of intratumoral drug are achievable with certain agents delivered via the hepatic artery with limited systemic exposure and therefore toxicity. Hepatic arterial infusion (HAI) in combination with systemic chemotherapy has evolved over the years and may be used in palliative, attempted downstaging, and adjuvant settings. The dramatic responses observed with HAI with floxuridine (FUDR) plus modern era systemic chemotherapy offer the possibility of resection and cure in selected patients with initially unresectable disease. Intra-arterial oxaliplatin and mitomycin-C have demonstrated advantages, but the cornerstone of HAI remains FUDR. FUDR is an ideal drug for HAI due to its short half-life, steep dose response curve, high hepatic extraction, and high total body clearance. HAI FUDR has consistently shown higher response rates than systemic chemotherapy alone, and some studies have shown a survival advantage. The most common toxicities include biliary sclerosis and gastrointestinal ulcers. The common drugs used for HAI therapy as well as dosing are discussed herein. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2025. |
