Pump-Based Hepatic Arterial Infusional Therapy

Hepatic arterial infusion (HAI) chemotherapy has been used over the last 30 years in patients with liver metastases from colorectal cancer and intrahepatic cholangiocarcinoma. Its rationale has been well established and is based on the preferential blood supply of these tumors from the hepatic artery and the first-pass extraction by the liver of some chemotherapy drugs. However, the generation of high-quality evidence for HAI treatment and the technical expertise required for administration have limited its widespread adoption. In this review, we will describe the relevant aspects of HAI treatment and summarize the evidence supporting its use in the treatment of colorectal cancer and intrahepatic cholangiocarcinoma. We will also review the complications associated with HAI and the precautions to minimize their incidence. Based on the current evidence, HAI has emerged as an effective and safe treatment alternative leading to renewed enthusiasm toward this therapeutic strategy. Future research will refine the selection of patients and the optimal combination with systemic treatments.