Guideline: Haip in the Management of Crc Liver Metastases

Over the past several years, important progress has been made in the treatment of patients with metastatic colorectal cancer. Median overall survival in these patients now extends beyond 2 years with a combination of modern systemic therapies1–8. Approximately 60% of patients present with liver-only or liver-predominant metastases, and if complete surgical resection is achieved in those patients, 5-year overall survival approaches 50%9–11. In patients with initially unresectable colorectal liver metastases (crlms), systemic therapy can, in up to 30% of patients, produce a tumour response sufficient to allow for resection and the possibility of long-term survival or cure12,13. An important goal of aggressive therapy in patients with initially unresectable crlms is therefore conversion to resectability. Although the response rate to systemic therapy is good in untreated patients, response rates to chemotherapy in the second-line setting remain disappointing. The most encouraging results are obtained with the addition of biologic agents to chemotherapy, achieving response rates of up to 20%–35% and a corresponding median survival of up to 1 year in the second-line setting14–18. Given the limited efficacy of systemic therapy beyond the first-line setting, patients could benefit from other treatments that would increase response and resectability rates. Hepatic arterial infusion pump (haip) chemotherapy has been extensively studied in patients with crlms. The rationale for arterial delivery of ABSTRACT