Hepatic Arterial Infusion Pump Chemotherapy for Colorectal Liver Metastases: Making a Comeback?

Nearly half of patients diagnosed with colorectal cancer will develop metastases during their lifetime; the majority of them were found within the liver. Surgical resection of liver metastases is the only curative therapy with 5-year survival rates ranging from 40 to 58 %. Unfortunately, less than 25 % of patients are eligible for resection. Before the advent of the modern systemic chemotherapy era, the administration of hepatic artery infusion (HAI)chemotherapy was widespread in the treatment of colorectal liver metastasis (CLM). However, due to a lack of demonstrated increased survival following HAI therapy compared to systemic chemotherapy alone, its use has fallen out of favor. Recently, multiple studies have demonstrated that HAI therapy may fill a role in the treatment of CLM disease in patients who have either progressed on first-line systemic chemotherapy in the palliative setting or are considered candidates for conversion from unresectable to resectable liver-only disease. The lack of large randomized clinical trials demonstrating clinical efficacy has precluded HAI chemotherapy use to be considered standard of care outside of a research setting in the adjuvant setting.