Treatment Options in Colorectal Liver Metastases: Hepatic Arterial Infusion

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Background: The liver is the most common site for metastases from colorectal cancer (CRC) with the majority of these patients having unresectable disease. Methods: This is a retrospective review of studies using hepatic arterial infusion (HAI) therapy to treat liver metastasis from CRC. A PubMed search of randomized controlled trials and retrospective studies from 2006 to present was conducted using the search terms ‘hepatic arterial infusion (HAI) therapy', ‘colorectal cancer', and ‘treatment of liver metastases'. Results: The first randomized studies comparing HAI to systemic therapy with 5-fluorouracil/leucovorin produced significantly higher response rates of 41 versus 14%. Systemic therapy has improved with the addition of irinotecan and oxaliplatin; however, the responses with HAI and these modern agents have also increased, with responses as high as 80%. For patients with wild-type KRAS, HAI and systemic therapy produced a median survival of 68 months. In patients with refractory disease, response rates are in the 30% range with a median survival of 20 months. Adjuvant HAI after liver resection has shown an increase of hepatic disease-free survival and overall disease-free survival when compared to systemic therapy alone in three of four randomized trials. A recent update of the adjuvant trials after liver resection at Memorial Sloan Kettering Cancer Center has shown a 5-year survival of 78%. Conclusion: HAI therapy has a role in treating hepatic metastases from CRC in both the resectable and unresectable setting.