The University of Toledo Translation Journal of Medical Sciences 
Haematology and Oncology Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e2 

Hepatic Arterial Infusion Chemotherapy versus Trans-
arterial Chemoembolization in Unresectable 
Hepatocellular Carcinoma: A Systematic Review and 
Meta-Analysis 

Ziad Abuhelwa, MD1*, Azizullah Beran, MD1, Sadik Khuder, PhD1, Ragheb Assaly, MD2, Danae M. Hamouda 
MD1 

1Division of Haemtology and Oncology , Department of Medicine, The University of 
Toledo, Toledo, OH 43614 
2Division of Pulmonary and Critical Care Medicine, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: ziad.abuhelwa@utoledo.edu

Published: 05 May 2023 

Introduction: Trans-arterial chemoembolization (TACE) has been one of the standard options for patients with 
unresectable hepatocellular carcinoma (HCC). Recent studies have shown that liver arterial infusion 
chemotherapy (HAIC) has favorable outcomes in these patients, but its use has been limited due to the need for 
technical expertise. In this systematic review and meta-analysis, we compared the efficacy and safety of HAIC vs. 
TACE for unresectable HCC. 

Methods: We performed a comprehensive literature search of PubMed, Embase, and Cochrane databases through 
January 12, 2022, for all peer-reviewed studies that compared the outcomes of HAIC vs. TACE in patients with 
large, unresectable HCC. Our primary outcomes were the objective response rate (ORR), disease control rate 
(DCR), and progressive disease (PD). The secondary outcomes were overall survival (OS), progression-free 
survival (PFS), and grade ≥3 adverse events (AEs). Pooled risk ratio (RR) and hazard ratio (HR) with the 
corresponding 95% confidence intervals (CIs) were obtained by the Mantel-Haenszel method within a random-
effect model. Heterogeneity was assessed using the Higgins I2 index.  

Results: Six studies (one randomized controlled trial [RCT], two non-randomized trials, and three retrospective 
cohort studies) were eligible for final analysis. A total of 899 patients were included for the final evaluation. 
HAIC was associated with significantly higher ORR (RR 2.70, 95% CI 2.06-3.55, P<0.001, I2=10.1%) and DCR 
(RR 1.42, 95% CI 1.19-1.70, P<0.001, I2=54.5%) and substantially reduced PD (RR 0.55, 95% CI 0.40-0.75, 
P<0.001, I2=56.6%) compared to TACE. The median OS was significantly longer in the HAIC group, ranging 
from 11.4 to 23.1 months vs. TACE, ranging from 4 to 16.1 months (HR 0.49, 95% CI 0.28-0.85, P=0.01 
I2=84.7%). The median PFS was significantly longer in the HAIC group, ranging from 5.5 to 9.6 months, vs. 
TACE, ranging from 1.5 to 5.4 months (HR 0.45, 95% CI 0.26-0.79, P=0.001, I2=84.6%). Notably, the incidence 
of grade≥3 AEs was lower in the HAIC group than in TACE (RR 0.61, 95% CI 0.47-0.80, P<0.001, I2=16.4%).  

https://dx.doi.org/10.46570/utjms.vol11-2023-732 

https://dx.doi.org/10.46570/utjms.vol11-2023-732
mailto:ziad.abuhelwa@utoledo.edu


https://dx.doi.org/10.46570/utjms.vol11-2023-732 UTJMS 11(1):e1-e2 

https://dx.doi.org/10.46570/utjms.vol11-2023-732 2 ©2023 UTJMS 

Conclusion: Compared to TACE, HAIC significantly improved ORR, DCR, and OS in unresectable HCC with a 
significantly better safety profile. However, our meta-analysis is hampered by the limited number of studies. 
Future large-scale multicenter RCTs are warranted to further evaluate the outcomes of HAIC vs. TACE in the 
management of unresectable HCC. 

https://dx.doi.org/10.46570/utjms.vol11-2023-732
https://dx.doi.org/10.46570/utjms.vol11-2023-732