Hepatic artery infusion chemotherapy: A resurgence

Abstract

In this manuscript, we comment on the article by Zhou et al, who assessed the efficacy of hepatic arterial infusion chemotherapy (HAIC) and its combination strategies for advanced hepatocellular carcinoma (HCC) using network meta-analysis methodology. We focus specifically on the potential advantages and role of HAIC in the treatment algorithm for advanced HCC. However, there remains numerous knowledge gaps before the role of HAIC can be established. There is significant heterogeneity of HAIC regimes with difficult interpretation of the clinical outcomes. Additionally, there is a lack of direct comparative data between HAIC, systemic chemotherapy, novel immunotherapies and targeted therapies. The underlying biochemical mechanisms that might explain the efficacy of HAIC and its effect on the HCC microenvironment requires further research. In the developing era of nanotechnology and targeted drug delivery systems, there is potential for integration of HAIC with novel technologies to effectively treat advanced HCC whilst minimising systemic complications.

Keywords: Hepatocellular carcinoma; Hepatic artery infusion chemotherapy; Immunotherapy; Targeted therapy; Transarterial chemoembolisation

Core Tip: In the current landscape of accumulating knowledge of hepatocellular carcinoma (HCC), tumour biology and developments in systemic therapies, the management of advanced HCC has become increasingly complicated. For hepatic arterial infusion chemotherapy (HAIC) to be first-line treatment for advanced HCC, the morbidity of hepatic artery port insertion must be at a low level, the HAIC regimens must be standardised, the optimal combination treatment strategy with HAIC and the role of HAIC in Western populations must be evaluated. The combined roles of HAIC with immunotherapy and delivery of chemotherapeutic drug nanoparticles to HCC tumour cells represents an exciting research and therapeutic strategy for advanced HCC.