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HAI Chemotherapy — SCE Medical Oncology MCQ

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HardGI CancersHAI ChemotherapySCE Medical Oncology

A 62-year-old man with liver metastases from CRC is considered for hepatic arterial infusion (HAI) chemotherapy with floxuridine. What is the rationale for HAI in CRC liver metastases?

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Correct answer: DHAI exploits the hepatic arterial blood supply of liver metastases (vs portal venous supply of normal hepatocytes) to deliver high local drug concentrations with reduced systemic toxicity — it is used in specialised centres for liver-dominant disease unresponsive to systemic therapy

Hepatic arterial infusion (HAI) chemotherapy delivers drugs directly into the hepatic artery via an implanted pump. CRC liver metastases derive >80% of their blood supply from the hepatic artery (vs normal hepatocytes which derive >75% from the portal vein). This creates a pharmacological advantage: HAI floxuridine achieves 100-400× higher hepatic drug concentrations than systemic administration. Memorial Sloan Kettering data shows HAI + systemic chemotherapy improves outcomes in unresectable liver-dominant mCRC. HAI is available at select UK centres.

Reference: ESMO 2024 mCRC; Kemeny et al JCO 1999; D'Angelica et al Lancet Oncol 2015