Hepatic Arterial Chemotherapy: Current and Future Approaches

Hepatic malignancies, both primary and metastatic, represent a substantial and growing global burden of disease. The majority of patients present with incurable disease, and systemic therapy alone is often limited by resistance and toxicity. Hepatic artery-directed chemotherapy delivery exploits the dual blood supply of the liver and the high first-pass hepatic extraction of select chemotherapeutic agents to achieve superior regional drug concentrations while minimizing systemic exposure. This review examines three distinct hepatic chemotherapy perfusion strategies: hepatic artery infusion pump therapy (HAIP), percutaneous hepatic artery infusion chemotherapy (PHAIC), and percutaneous hepatic perfusion (PHP). For each modality, we review the mechanistic rationale, technical approach, patient selection criteria, clinical evidence, and associated complications. Collectively, these strategies represent complementary and increasingly validated tools in the multidisciplinary management of hepatic malignancies.