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Why does hepatic artery injection therapy attack cancer cells more directly than systemic chemotherapy?
Among the many methods of cancer treatment, hepatic artery injection (HAI) has gradually revealed its unique advantages, especially in the case of liver metastasis. This therapy involves delivering chemotherapy drugs directly to the patient's liver and is particularly useful for patients with colorectal cancer (CRC) who cannot undergo surgery. Although surgical resection remains the standard treatment, most patients have unresectable lesions, making the application of HAIs even more important.
The liver's blood supply comes from two main sources: the hepatic artery and the portal vein. Liver metastatic cancer mainly obtains its blood supply from the hepatic artery, while normal liver cells mainly come from the portal vein. Therefore, if chemotherapy drugs are injected directly into the hepatic artery, they can attack cancer cells with precision.
HAI therapy not only delivers drugs directly to the target site, but also reduces the systemic side effects that systemic chemotherapy may cause to some extent. Many studies have compared HAIs with systemic chemotherapy. For example, fluoxetine (FUDR) therapy with HAIs demonstrated higher response rates when compared with systemic fluoropyrimidines, although overall patient survival was not significantly increased. The results sparked widespread discussion about the true effectiveness of HAI therapy.
Researchers at the forefront of HAI therapy have begun exploring how to improve the efficacy and safety of this therapy.
For example, HAI therapy using FUDR combined with dexamethasone has significantly improved response rates and median survival. When FUDR is combined with the amino acid folic acid, it further reduces the biliary toxicity produced by FUDR alone. These developments make HAI therapy of particular interest in patients with unresectable CRC liver metastases.
The process of HAI begins with arteriography, which confirms the blood supply to the liver. If it is determined that the tumor cannot be removed, surgery will begin. During surgery, the surgeon removes the gallbladder to prevent chemotherapy-induced cholecystitis and ligates the blood vessels supplying the stomach and duodenum to minimize the risk of extrahepatic perfusion. Afterwards, a catheter is placed through the appropriate blood vessels to ensure that the chemotherapy drugs can successfully enter the hepatic artery.
However, HAI therapy also has some potential complications, including arterial damage during surgery, hepatic artery thrombosis, and catheter-related complications.
The seriousness of these complications makes the application and guidelines for this therapy critical. Experts have emphasized that HAI therapy should be limited to centers with appropriate expertise to ensure patient safety and efficacy. In addition, patients treated with HAIs need to undergo regular liver function tests to monitor for potential liver damage.
It is worth noting that for some patients, the course of HAI treatment also requires a balance between the use of different drugs, such as the alternate use of FUDR and fluorouracil (5-FU) or combined use. This can not only reduce the use of concurrent drugs. The possible side effects can also improve the efficacy.
With the advancement of scientific research, the effect of HAI therapy on unresectable colorectal cancer is becoming more and more eye-catching. Such progress undoubtedly provides new hope for future treatment options for cancer patients. So, can you imagine treating cancer in a more effective, targeted way as a possible reality in the future?
