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Hepatic arterial infusion chemotherapy (HAIC) for liver cancer | CION Cancer Clinics
Hepatic arterial infusion chemotherapy delivers chemotherapy through a thin tube placed in the artery that feeds the liver. It is mainly considered for large primary liver cancers, or those grown into the portal vein, that have not spread beyond the liver. This page explains how HAIC works, who the tumour board might offer it to, how it compares with TACE and immunotherapy, and who it does not suit. At CION Cancer Clinics, a multidisciplinary tumour board weighs your liver function and your scans before recommending any treatment.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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The short answer
What is hepatic arterial infusion chemotherapy?
Hepatic arterial infusion chemotherapy, usually shortened to HAIC, is chemotherapy given straight into the main artery that feeds the liver. It is mostly considered for primary liver cancer (hepatocellular carcinoma, or HCC) that is large or has grown into the portal vein, the big vein that carries blood into the liver, when the cancer has not spread outside the liver.
Why give it through the liver's artery
Liver tumours draw most of their blood from the hepatic artery, while healthy liver relies more on the portal vein. Sending the drug down that artery puts a much stronger dose into the tumour than a drip in the arm can, with less of it reaching the rest of the body.
Where it sits among the choices
HAIC is used widely in Japan, China and Korea. Major European and American guidelines do not yet list it as a standard first treatment, because most of the trials come from a few Asian centres. For most people with advanced HCC, immunotherapy combinations such as atezolizumab plus bevacizumab remain the usual starting point. HAIC is a choice made case by case at a tumour board.
This page is about primary liver cancer. Infusion pumps for bowel cancer that has spread to the liver are covered on the colon cancer pages.What the team weighs
Who might be offered HAIC?
Three things decide it: where the cancer is, how well the liver is working, and how fit you are.
The cancer stays inside the liver
HAIC only treats what the artery reaches. If scans show spread to the lungs, bones or distant lymph nodes, treatment that travels through the whole body usually makes more sense.
The tumour is large or has entered the portal vein
Tumour growing into the portal vein is called portal vein tumour thrombus. It often rules out TACE, because blocking the artery as well could starve the healthy liver. HAIC fills the artery with drug without blocking it.
Often discussed when
- TACE is not safe or has stopped working
- The tumour is too large for ablation
- Shrinking the tumour might make surgery possible later
The liver is still coping
Most people offered HAIC have Child-Pugh A liver function, the group whose liver is working well despite cirrhosis. Some with early Child-Pugh B are considered with great care.
You are up and about
HAIC needs a procedure to place the catheter and repeated sessions. Someone who spends most of the day in bed is unlikely to benefit.
Not sure whether this applies to you?
Ask an oncologistHow it is done
What happens during HAIC treatment?
The tumour board review
Your scans, blood tests and liver scores are reviewed by the oncologist, interventional radiologist, surgeon and hepatologist together. They decide whether HAIC fits better than the alternatives.
Mapping the arteries
An interventional radiologist passes a thin tube from the groin or wrist and takes X-ray pictures of the liver's arteries. Small side branches to the stomach may be blocked so the drug does not reach them.
Placing the catheter or port
Some centres place the catheter afresh for each session. Others fit a small port under the skin, like those used for ordinary chemotherapy, so the line can be reused.
The infusion
The drugs run in slowly through a pump, usually over a day or longer, often in hospital. Common combinations include oxaliplatin with fluorouracil, or cisplatin with fluorouracil. Your team will explain the exact plan.
Scans to check the response
After a few sessions a repeat CT or MRI shows whether the tumour is shrinking. If it is not, the team changes course rather than carrying on.
Side by side
How does HAIC compare with TACE and systemic treatment?
HAIC
TACE or systemic treatment
Drug flows through the artery, which stays open
TACE blocks the artery after the drug, which is risky with a blocked portal vein
Treats the liver only
Systemic treatment reaches cancer anywhere in the body
Evidence comes mainly from Asian trials
Immunotherapy combinations are backed by large international trials
Needs a catheter procedure and repeated hospital stays
Systemic treatment is a drip or tablets, usually as a day patient
Offered at fewer hospitals in India
TACE and systemic treatment are widely available in Hyderabad
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Being clear
Who is HAIC not suitable for?
HAIC is not for everyone with a large liver tumour. It usually does not suit people whose cancer has already spread beyond the liver, people with Child-Pugh C liver function, and people too unwell to manage a procedure and hospital stays.
Liver and kidney problems
A liver that is failing, with deepening jaundice, a lot of fluid in the belly or episodes of confusion, is unlikely to tolerate it. Cisplatin can strain the kidneys, so poor kidney function may change the drugs or rule the approach out.
Blood vessel anatomy
Some people have arteries that make it hard to steer the catheter safely, or that cannot be protected from leaking drug into the stomach. The angiogram answers this, and sometimes it is the reason HAIC is dropped.
Side effects to know about
Tiredness, nausea, a low blood count and stomach pain can occur. Oxaliplatin can cause numbness or tingling in the hands and feet. The catheter itself can block, move or become infected. The chemotherapy with liver disease page explains how doses are adjusted when the liver is damaged.
Being straight with you
What this page cannot tell you
It cannot tell you whether HAIC is right for you. That depends on your scans, your blood tests and how your liver and body are coping, and it is decided by specialists who have looked at all of it together.
The evidence is still being settled
Trials of HAIC have shown promising tumour shrinkage, but most were run in a small number of centres in one region, with patients who may differ from those in India. Doctors honestly disagree about where HAIC should sit. If two specialists give you different advice, that is a fair reflection of the evidence. Ask each one why.
What CION does and does not do
CION's medical oncologists see you, review your case at the tumour board and give systemic treatment. The catheter and angiogram for HAIC are coordinated through accredited partner hospitals with interventional radiology teams. Your team will tell you where each step takes place.
If you have been told about HAIC and want a second view, bring your scans and reports to a consultation.Questions we are asked
Common questions about HAIC for liver cancer
Is HAIC the same as TACE?
No. Both send treatment through the liver's artery, but TACE then blocks the artery to starve the tumour. HAIC keeps the artery open and lets drug flow in steadily over hours. That is why HAIC can sometimes be used when the portal vein is blocked and TACE would be too risky for the healthy liver.
Is HAIC available in Hyderabad?
It is offered at fewer hospitals than TACE, because it needs an experienced interventional radiology team and inpatient care. Your oncologist can tell you where it is being done and whether travel or waiting would change the plan. CION coordinates it through accredited partner hospitals when the tumour board recommends it.
Can HAIC be combined with immunotherapy or tablets?
Some trials are testing HAIC alongside immunotherapy or targeted tablets such as lenvatinib. The early results are interesting, but these combinations are not yet an established standard. Your oncologist can explain whether a combination is reasonable for you, or whether it should only happen within a trial.
Can HAIC shrink a tumour enough for surgery?
Sometimes. A tumour that was too large to remove may shrink enough for a surgeon to reconsider. This happens in a minority of people, and nobody can promise it at the start. The surgeon will reassess after the follow-up scans.
Will I need to stay in hospital?
Usually yes, for the catheter procedure and for each infusion, since the drug runs in slowly through a pump. With a port under the skin, some centres manage parts of the treatment as day care. Ask how many nights each session needs before you plan travel from a district.
Is HAIC painful?
The catheter is placed under local anaesthetic, often with sedation, so you feel pressure more than pain. Some people feel a dull ache in the upper right belly during the infusion. Tell the nurse if pain builds, because it can mean the drug is reaching the stomach and the line needs checking.
Does Aarogyasri or insurance cover HAIC?
Cover varies. Some policies treat it as chemotherapy, some as an interventional procedure, and some query it because it is less established. Scheme rules change, so ask the hospital for a written, itemised estimate and check with the scheme or insurer before you start.
What should I ask before agreeing to HAIC?
Ask why HAIC rather than TACE or systemic treatment, how often the team does it, what the plan is if the tumour does not respond, and who to call if the line causes trouble at home. Bring a family member to write down the answers.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- EASL — EASL Clinical Practice Guidelines: management of hepatocellular carcinoma
- American Cancer Society — Chemotherapy for Liver Cancer
- National Cancer Institute — Liver Cancer Treatment
- American Cancer Society — Treatment of Liver Cancer, by Stage
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Portal vein tumour thrombosis explainedThe situation where HAIC is most often discussedWhen TACE is not safeWhy the artery cannot always be blockedSystemic treatment for liver cancer: the options todayThe standard first treatments HAIC is weighed againstSystemic treatment with Child-Pugh B liver functionWhen the liver is weaker, the choices narrow
Talk to us
Has HAIC been suggested and you are unsure?
Bring your scans and reports and a CION medical oncologist will go through whether HAIC, TACE or systemic treatment fits your liver and your cancer. One helpline serves every CION centre.