The role of hepatic arterial infusion chemotherapy in locally advanced hepatocellular carcinoma

This is the authors' abstract. We don't add key points for this paper.

Patients with locally advanced hepatocellular carcinoma (HCC) are often characterized by high intrahepatic tumor burden, multifocal or infiltrative growth, and/or macrovascular invasion. For many of these patients, liver-dominant progression and subsequent hepatic decompensation are the main drivers of poor prognosis. Hepatic arterial infusion chemotherapy (HAIC) leverages the arterial blood supply of HCC by delivering cytotoxic agents continuously or intermittently into tumor-feeding hepatic arteries, thereby achieving higher locoregional drug exposure with comparatively reduced systemic toxicity. In recent years, HAIC, particularly FOLFOX-based regimens, has generated robust high-level evidence in selected Asian populations, demonstrating improved objective response and survival outcomes in patients with intrahepatic-dominant HCC. Moreover, combination strategies integrating HAIC with targeted agents, immune checkpoint inhibitors, transarterial chemoembolization, or radiotherapy are increasingly used to intensify tumor shrinkage, facilitate conversion to curative-intent resection/ablation, and improve disease control. This review critically appraises the current evidence supporting HAIC in locally advanced HCC, discusses patient selection, combination strategies, conversion therapy, safety considerations, and future research priorities.