Intra-arterial chemotherapy (IAC) is an image-guided procedure in which a thin tube (catheter) is guided into the artery that feeds a tumor, and cancer drugs are infused straight through it. In liver cancer it is called hepatic arterial infusion chemotherapy (HAIC), and in Japan it is one of the most widely used treatments for advanced liver cancer. In a Chinese phase 3 trial of liver tumors 7 cm or larger, median survival was 23.1 months with HAIC compared with 16.1 months with chemoembolization (TACE).
Based on the Japanese Society of Interventional Radiology (JSIR) guideline and studies from the US, China and Europe, this article explains how intra-arterial chemotherapy works, who it suits, how the procedure is done, results from overseas trials and how side effects are managed.
Treatment status · Hepatic arterial infusion chemotherapy is an approved treatment included in Asian guidelines such as those of Japan and China. In the US, an implanted pump is used to deliver drugs for colorectal liver metastases. All figures below come from clinical trials and real-world treatment of patients. This article is general information, not a treatment recommendation.
What intra-arterial chemotherapy is
Standard chemotherapy is given into an arm vein and circulates through the whole body. Intra-arterial chemotherapy instead sends the drug directly into the artery of the organ that contains the tumor. The same dose reaches the tumor at a much higher concentration, while less of it spreads around the body. That is the core idea.
The liver suits this approach best. The normal liver gets most of its blood from the portal vein, but liver cancer is fed mainly by the hepatic artery. Drugs infused into the hepatic artery therefore concentrate in the tumor, and much of the remainder is filtered as it passes through the liver. A 2026 review in the journal Liver Cancer by researchers at Sun Yat-sen University Cancer Center described HAIC as "an integral modality for advanced HCC, especially for patients with extensive liver tumors or portal vein tumor thrombus".
The same method is used in other organs, with different drugs and techniques for each. This article focuses on liver infusion, where the research is most extensive.
Who it is used for
HAIC is mainly used for liver cancer that is hard to remove in one step with surgery or radiofrequency ablation. The review and the Japanese guideline describe the following candidates.
| Item | Details | Notes |
|---|---|---|
| Good fit | Liver cancer with portal vein tumor thrombus | Vessel invasion often makes embolization difficult |
| Good fit | Large or multiple tumors within the liver | Locally advanced disease without spread outside the liver |
| Liver function | Child-Pugh A or ALBI grade 1 are the best candidates | Usually not done for Child-Pugh C or ALBI grade 3 |
| Added care | Antiviral prophylaxis for hepatitis B carriers | Prevents hepatitis flare during chemotherapy |
| Relation to surgery | Surgery comes first when possible | HAIC can also shrink tumors as a bridge to surgery |
Chen QF, et al. Liver Cancer 2026, doi:10.1159/000551934 / Ueshima K, et al. Liver Cancer 2022;11:407–425.
How liver function scores and stage are checked is explained in tests before liver cancer procedures.
How the procedure is done
There are three main ways to deliver drugs into the hepatic artery, depending on the country and hospital. In each case the first step is angiography: a catheter is inserted through an artery in the groin or wrist and guided under X-ray to the hepatic artery.
| Method | Main country | How it works | Features |
|---|---|---|---|
| Implanted port | Japan | Catheter tip placed in the hepatic artery, other end connected to a small port under the skin | Repeated outpatient infusions by needle into the port |
| Catheter per cycle | China | A catheter is inserted for each treatment, the drug is infused, then the catheter is removed | FOLFOX-based drugs every 3 weeks |
| Surgical pump | United States | A pump is implanted under the abdominal skin by surgery and connected to the hepatic artery | Pump is refilled every 14 days |
Ueshima K, et al. Liver Cancer 2022 / Lyu N, et al. J Clin Oncol 2022 / Memorial Sloan Kettering patient guide.
Japan: implanted port
In their 2022 English guideline, the Japanese Society of Interventional Radiology and the Japanese Society of Implantable Port Assisted Treatment described the port system as a method "developed mainly in Japan". With a coin-sized port under the skin, each treatment needs only a needle into the port rather than a new catheter. The basic regimen is FP (5-FU with cisplatin). Japanese researchers also developed New-FP, in which cisplatin is mixed with an oily contrast agent (Lipiodol) so that it stays in the tumor longer.
China: catheter per cycle
Large trials at Sun Yat-sen University Cancer Center infused oxaliplatin, fluorouracil and leucovorin (FOLFOX) into the hepatic artery. A catheter is placed every 3 weeks and removed after the infusion, so no device stays in the body.
United States: surgical pump
Memorial Sloan Kettering Cancer Center (MSK) uses hepatic artery infusion pumps mainly for colorectal liver metastases. A titanium pump about the size of a hockey puck is placed under the abdominal skin under general anesthesia and connected to the hepatic artery. Surgery takes about 1.5 to 2 hours, the hospital stay is 1–3 days and recovery takes about 4 weeks. The pump is refilled every 14 days in a 10–15 minute visit. Other local treatments for colorectal liver metastases are covered in thermal ablation for colorectal liver metastases.
Results from overseas trials
The benefit of HAIC is best shown by two randomized phase 3 trials from China, both published in the Journal of Clinical Oncology.
| Study | Patients | Comparison | Median survival | Response rate |
|---|---|---|---|---|
| Li et al. (2022) | 315 patients with tumors ≥7 cm, no vessel invasion or spread outside the liver | FOLFOX-HAIC vs TACE | 23.1 vs 16.1 months | 46% vs 18% |
| FOHAIC-1 (2022) | 262 patients with advanced liver cancer (65.6% with vessel invasion) | FOLFOX-HAIC vs sorafenib | 13.9 vs 8.2 months | 31.5% vs 1.5% |
Li QJ, et al. J Clin Oncol 2022, doi:10.1200/JCO.21.00608 / Lyu N, et al. J Clin Oncol 2022, doi:10.1200/JCO.21.01963.
In the large-tumor trial, progression-free survival was 9.6 months with HAIC versus 5.4 months with TACE, and complete response was 13% versus 3%. In FOHAIC-1, tumors shrank enough for surgery in 16 HAIC patients (12.3%), and 15 of them went on to surgery or ablation. Their median survival was 20.8 months, with a 1-year survival rate of 93.8%.
Japan's New-FP regimen has also shown good results. According to data gathered in the 2026 review, median survival with New-FP in liver cancer with vessel invasion was 30.4 months, compared with 13.2 months with sorafenib, and the response rate was 71%. The conversion rate to surgery after New-FP was 16.3%, and those patients had a 5-year survival rate of 56%. Studies combining HAIC with targeted drugs and immunotherapy are now active, and a triple combination reported a response rate of 77%.
Side effects and how they are managed
Because the drug concentrates in the liver, whole-body side effects tend to be relatively mild. In FOHAIC-1, grade 3–4 treatment-related side effects occurred in 20.3% of the HAIC group versus 48.1% with sorafenib. In the large-tumor trial, serious adverse events were 19% versus 30% with TACE.
| What to watch | What was reported | Management |
|---|---|---|
| Stomach or duodenal ulcer | Can occur if drug flows into stomach vessels (4.7% in a French study of 43 patients) | Prevented with acid-reducing medicine; report upper abdominal pain promptly |
| Catheter displacement | 16.3% in the same study, mostly within 1 month | Checked by angiography and repositioned |
| Port-site infection | 4.7% in the same study | Check daily for swelling or heat around the port |
| Fever or jaundice | When to call, per the MSK guide | Call for fever of 38°C or higher, dark urine or yellow eyes |
Chevallier O, et al. Diagnostics 2021;11(3):399 / Memorial Sloan Kettering patient guide.
In the study from Dijon University Hospital in France, there were no deaths related to the port procedure. Most device problems were solved by a repositioning procedure, so keeping scheduled angiography or flow checks is important. The MSK guide advises patients with a pump to avoid lifting more than 4.5 kg, running, contact sports, saunas and heating pads, and to check with their team before flying.
How it differs from TACE and Y-90
All three are IVR procedures using a catheter in the hepatic artery, but they differ in what is delivered and how often.
| Treatment | What goes into the artery | Frequency | Main use |
|---|---|---|---|
| HAIC | Cancer drugs only (the vessel is not blocked) | Repeated at set intervals | Large tumors, portal vein tumor thrombus |
| TACE | Cancer drugs plus embolic material that blocks the vessel | One session at a time, as needed | Intermediate-stage liver cancer |
| Radioembolization (Y-90) | Tiny radioactive beads | Usually 1–2 sessions | Selected liver cancers with preserved liver function |
See TACE (transarterial chemoembolization) guide and Y-90 radioembolization for liver cancer. The latest results of embolization combined with immunotherapy are in EMERALD-3 results.
Where it is available in Japan and abroad
| Region | Current status | Basis |
|---|---|---|
| Japan | One of the most commonly used treatments for advanced liver cancer; joint society guideline (Japanese 2018, English update 2022) | JSIR and Japanese Society of Implantable Port Assisted Treatment |
| China | Benefit confirmed in two phase 3 FOLFOX-HAIC trials; included in Asian guidelines | Sun Yat-sen University Cancer Center |
| United States | Surgical pump for colorectal liver metastases; PUMP trial adding pump therapy to standard chemotherapy registered | MSK, ClinicalTrials.gov NCT05863195 |
US and European liver cancer guidelines do not yet list HAIC as standard care, so few Western hospitals offer it.
In Japan, the radiology (IVR) departments of university hospitals and cancer centers often provide this treatment. Japanese public insurance usually does not cover overseas patients, so costs and the schedule of repeated sessions should be confirmed directly with the hospital. The port method requires several treatments at the same hospital, so planning the length of stay or return trips in advance helps. For an overview of IVR procedures, see IVR and RFA.
Points for patients to check
- Given my liver function score (Child-Pugh, ALBI) and the extent of vessel invasion, is HAIC suitable for me?
- Will you use a port or a catheter for each cycle?
- How many sessions, how many weeks apart, and when will CT or MRI check the response?
- If the tumor shrinks, can I move on to surgery or radiofrequency ablation?
- Can targeted drugs or immunotherapy be added?
For consultation preparation, see also five questions before an RFA consultation.
Frequently asked questions
How is intra-arterial chemotherapy different from regular chemotherapy?
Regular chemotherapy is given into a vein and travels through the whole body. Intra-arterial chemotherapy is infused directly into the artery feeding the tumor, raising the drug level around the tumor and lowering the amount reaching the rest of the body. In liver cancer it is called hepatic arterial infusion chemotherapy (HAIC).
Is HAIC more effective than TACE?
In a Chinese phase 3 trial of 315 patients with liver tumors 7 cm or larger, median survival was 23.1 months with HAIC and 16.1 months with TACE. The best choice still depends on tumor size and vessel invasion, so the medical team decides after reviewing the scans.
Does having a port make daily life difficult?
The small port sits under the skin and is hardly visible, and most people live normally except on infusion days. Report any swelling or fever around the port promptly and keep scheduled check-ups.
Can surgery become possible after treatment?
Yes, this has been reported. In FOHAIC-1, 12.3% of HAIC patients became eligible for surgery or ablation after their tumors shrank, and in Japanese New-FP data, patients who went on to surgery had a 5-year survival rate of 56%.
This article summarizes overseas research and guidelines as general information and is not medical advice. Please discuss treatment choices with the doctors who examine you.
Sources (checked October 27, 2026)
- Li QJ, et al. Hepatic Arterial Infusion of Oxaliplatin, Fluorouracil, and Leucovorin Versus Transarterial Chemoembolization for Large Hepatocellular Carcinoma: A Randomized Phase III Trial. Journal of Clinical Oncology. 2022. doi:10.1200/JCO.21.00608
- Lyu N, et al. Arterial Chemotherapy of Oxaliplatin Plus Fluorouracil Versus Sorafenib in Advanced Hepatocellular Carcinoma: A Biomolecular Exploratory, Randomized, Phase III Trial (FOHAIC-1). Journal of Clinical Oncology. 2022. doi:10.1200/JCO.21.01963
- Ueshima K, Komemushi A, Aramaki T, et al. Clinical Practice Guidelines for Hepatic Arterial Infusion Chemotherapy with a Port System Proposed by the Japanese Society of Interventional Radiology and Japanese Society of Implantable Port Assisted Treatment. Liver Cancer. 2022;11(5):407-425.
- Chen QF, Chen S, Jiang X, Wang J, Zhao M. Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma in the Era of Systemic Therapies (2020–2025). Liver Cancer. 2026.
- Chevallier O, Mvouama S, Pellegrinelli J, et al. Percutaneous Implantation of a Microcatheter-Port System for Hepatic Arterial Infusion Chemotherapy of Unresectable Liver Tumors: Technical Feasibility, Functionality, and Complications. Diagnostics. 2021;11(3):399.
- Memorial Sloan Kettering Cancer Center. About Your Liver (Hepatic Artery) Infusion Pump. Patient guide.
- ClinicalTrials.gov. Testing Pump Chemotherapy in Addition to Standard of Care Chemotherapy Versus Standard of Care Chemotherapy Alone for Patients With Unresectable Colorectal Liver Metastases: The PUMP Trial. NCT05863195.