Hepatic Arterial Infusion Chemotherapy for Intrahepatic Cholangiocarcinoma

Intrahepatic cholangiocarcinoma (ICC) represents a formidable challenge due to its aggressive nature and frequent presentation with multifocal disease and intrahepatic metastasis. While surgical resection remains the cornerstone of treatment for localized disease, many patients are deemed unresectable at diagnosis. As systemic therapies such as chemotherapy, immunotherapy, and targeted agents advance, the role of liver-directed therapies, including hepatic arterial infusion (HAI) chemotherapy, has evolved significantly. The National Comprehensive Cancer Network (NCCN) now recommends HAI chemotherapy for patients with unresectable or metastatic ICC without extrahepatic spread. Several studies underscore the efficacy of combining HAI chemotherapy with systemic treatments over either modality alone in improving progression-free and overall survival rates. In this chapter we will review the current literature, emphasizing studies and ongoing trials that elucidate the evolving role of HAI chemotherapy in the management of unresectable ICC. By examining outcomes and exploring therapeutic strategies, this review aims to provide insights into optimizing treatment approaches for this challenging malignancy.