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P34. Oncologic outcomes of hepatic arterial infusion (HAI) chemotherapy for unresectable colorectal liver metastases: a multicenter analysis from the international HAI Consortium Research Network (HCRN)

Thursday, March 5, 2026
11:35 AM - 11:42 AM MST
Location: 301D
Introduction:

HAI pump chemotherapy can provide durable disease control and enable conversion to resection for unresectable colorectal liver metastases (uCRLM). Prior studies report outdated regimens or are limited to high-volume centers. The HCRN established an international registry to evaluate real-world, multicenter outcomes. This study evaluates oncologic outcomes of HAI for patients with uCRLM.


Methods: Patients receiving HAI for uCRLM were identified from the HCRN registry (2000-2024). Demographics, clinical features, and perioperative outcomes were analyzed. Survival was estimated by Kaplan-Meier and evaluated by multivariable Cox regression. Patients with < 12 mo follow-up were excluded. Outcomes were stratified by prior chemotherapy; comparisons used Kruskal-Wallis, Fisher’s exact, or Mantel-Haenszel tests.


Results: 957 patients were included from 33 centers (median age 54 years, 61% male, 78% white). 87% had synchronous CRLM, 56% had >10 CRLM, and 18% had extrahepatic disease. 98% received prior chemotherapy (median 12 cycles). 283 (31%) patients had an HAI-specific complication. 90-day mortality was 2%. 97% received FUDR (median 6 cycles). Time to FUDR and systemic therapy were 18 and 33 days, respectively. At 6 mo, 4% had a complete response, 31% partial response, 32% stable disease, and 32% progression of disease. Biliary sclerosis occurred in 6%.

Of the 623 patients with adequate follow-up, median OS was 23 mo (IQR 12.2-40.9), PFS 7 mo (3.3-12.9), hepatic PFS (hPFS) 9.7 mo (4.9-17.2), and extrahepatic PFS (ePFS) 9.4 mo (3.9-17.9). Conversion to resection occurred in 10%, was the strongest predictor of OS (HR 0.36, 95% CI 0.23-0.57, p< 0.001), and independently predicted PFS, hPFS, and ePFS. Nonwhite race (HR 2.36, 95% CI 1.17-4.76, p=0.02), hepatic disease burden (HR 1.54, 95% CI 1.11-2.12, p=0.01), and KRAS mutation (HR 1.44, 95% CI 1.10-1.88, p=0.01) predicted worse OS.

Less pre-HAI chemotherapy (0 vs 1-12 vs 13+ cycles) was associated with longer PFS (median 10 vs 8 vs 5 mo, p=0.003), hPFS (14 vs 10 vs 8 mo, p< 0.001), and ePFS (10 vs 10 vs 8 mo, p=0.049), but not median OS (22 vs 19 vs 18 mo, p=0.155).


Conclusions: HAI resulted in durable disease control across centers. Conversion to resection was the dominant predictor of survival, and heavier pre-HAI chemotherapy was associated with inferior PFS, suggesting earlier integration may improve long-term outcomes.

Learning Objectives:

  • Describe real-world, multicenter oncologic outcomes of hepatic arterial infusion (HAI) pump chemotherapy for unresectable colorectal liver metastases, including response rates, progression-free survival, and factors associated with overall survival.
  • Recognize and apply key prognostic factors—such as conversion to resection, hepatic disease burden, and extent of prior chemotherapy—to identify patients who may benefit most from early HAI integration.