Locoregional Therapy Pressure-Enabled Drug Delivery for Liver Cancers

Hepatic malignancies account for a substantial portion of global cancer mortality, with hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (IHC), and metastatic liver disease representing the most common diagnoses. While surgical resection and liver transplantation remain curative options for eligible patients, most patients are diagnosed at stages unsuitable for surgery. This has shifted medical management towards locoregional therapies (LRTs) which are often catheter-directed. Of these interventions, the use of conventional end-hole catheters for therapeutic infusion has been a mainstay of treatment, but this method is constrained by retrograde particle escape and elevated tumoral interstitial fluid pressure. Together, these factors limit drug penetration into the tumor microenvironment. Pressure-enabled drug delivery (PEDD), achieved through balloon-occlusion or microvalve-based catheter platforms, has emerged as a strategy to overcome these limitations. This narrative review synthesizes current evidence regarding PEDD and contextualizes its role within the broader LRT landscape. Preclinical studies and early clinical data illustrate improved drug-delivery characteristics, acceptable safety profiles, and highlight the potential for adaptation to regional immunotherapy regimens. However, while PEDD represents a promising advance in catheter-based hepatic oncologic therapy, prospective randomized comparisons against conventional infusion remain limited, and significant investigation is needed to establish its definitive role in interventional oncology.