Hepatic arterial infusion versus systemic chemotherapy for colorectal cancer liver metastasis

The standard treatment for unresectable liver-confined metastatic disease from colorectal cancer (CRC) is systemic chemotherapy (SCT). Unfortunately, the prognosis of these patients is dismal and SCT is virtually never curative. Although locoregional treatments such as hepatic arterial infusion (HAI) claim the advantage of delivering higher doses of anticancer agents directly into the diseased organ (i.e., the liver), the benefit in terms of overall survival (OS) is unclear and the use of HAI is debated. This meta-analysis quantitatively summarizes the results of the ten randomised controlled trials (RCT) comparing HAI with systemic chemotherapy (SCT). Our findings show that administration of fluoropyrimidines through HAI yields higher tumor response rates as compared to the SCT regimens used in the analysed RCT. However, this anticancer activity does not translate into a significant survival advantage for patients treated with HAI as compared to those given SCT. Also considering that modern SCT can achieve higher response rates as compared to the regimens adopted in the analysed RCT, the currently available evidence does not support the clinical or investigational use of fluoropyrimidine-HAI alone for the treatment of patients with unresectable CRC liver metastases.