As per the latest data of the International Agency for Research on Cancer,
more than 8 million individuals die annually owing to the exacerbation of a given
neoplasm, and the total number of annual deaths due to hepatocellular carcinoma
(HCC) is 0.78 million, the second-highest of all cancer-related deaths. HCC has a very
poor prognosis, reflected by the fact that the incidence-to-mortality ratio of HCC has
been estimated to be more than 90%. Liver cancer is generally diagnosed only in the
advanced clinical stage because HCC tends to be clinically silent during the early
stages. With regard to HCC management, transarterial chemoembolization (TACE) and
hepatic arterial infusion chemotherapy (HAIC), as well as molecularly targeted agents
such as sorafenib and lenvatinib, have shown promising benefits for advanced HCC.
However, even though the Barcelona Clinic Liver Cancer staging system has been
widely accepted, controversies still exist regarding the best choice for the management
of HCC in individual cases. In this chapter, we infer that HAIC treatment is not inferior
to molecularly targeted therapies for the treatment of advanced HCC—particularly in
case of intravascular invasion in both compensated and decompensated cirrhotic
patients. Furthermore, the rate of adverse events leading to discontinuation of antitumor
treatment appears relatively low. Given the hepatic function reserve preservation
afforded by HAIC chemotherapy, we suggest that HAIC should be considered as an
alternative strategy even for advanced-HCC patients with decompensated cirrhosis,
who do not respond to TACE.
Keywords: 5-fluorouracil, Advanced stage, Chemotherapy, Child–Pugh
classification, Cisplatin, Hepatic arterial infusion, Hepatic functional reserve,
Hepatocellular carcinoma, Lenvatinib, Molecularly targeted therapies, Overall
survival, Portal invasion, Progression-free survival, Reservoir, Sorafenib.
