Hepatic arterial infusion chemotherapy for metastatic colorectal cancer: real-world outcomes of intensification and salvage strategies

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BACKGROUND: Hepatic arterial infusion chemotherapy (HAIC) is a valuable option in patients with liver-dominant metastatic colorectal cancer (mCRC) but remains underutilized due to limited data. METHODS: We conducted a retrospective study of mCRC patients treated with HAIC in an expert center between 2010 and 2024. Patients were grouped according to treatment setting: intensification (INT; 1st/2nd line) and salvage (SALV; ≥3rd line). RESULTS: Among 213 patients, 99 received INT-HAIC and 114 SALV-HAIC. SALV patients had worse baseline features, including more Eastern Cooperative Oncology Group performance status (ECOG PS ≥ 2; 16% vs 4%), RAS mutation (55% vs 45%), extra-hepatic disease (45% vs 23%), liver burden >50% (65% vs 40%), and prior intravenous (IV) oxaliplatin progression (41% vs 16%). Oxaliplatin was the main agent used (81% INT, 78% SALV). Objective response and disease control rate were 51%/77% (INT) and 32%/60% (SALV). Median progression-free survival (PFS), hepatic PFS, and overall survival were 7.6, 9, and 23 months (INT) and 3.7, 5.7, and 12 months (SALV). Prior IV oxaliplatin progression was associated with poorer outcomes of oxaliplatin-HAIC in the INT setting. Radical liver treatment followed HAIC in 28% (INT) and 7% (SALV). Grade 3-4 adverse events occurred in 42.7% and catheter complications in 26.7%. Concomitant antiangiogenic therapy was associated with a higher rate of catheter-related complications (44% vs 22%) and remained associated after adjustment for clinical covariates. CONCLUSIONS: HAIC demonstrates promising efficacy and manageable toxicity in liver-dominant mCRC when delivered in expert multidisciplinary centers, although careful patient selection and caution with concomitant antiangiogenic therapy are warranted.

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