Locoregional immuno-chemotherapy in liver carcinoma--present and future

Locoregional infusion therapy has several theoretical advantages over systemic therapy for the treatment of primary or metastatic liver tumors. At present, hepatic arterial infusion (HAI) chemotherapy clearly improves the response rate over systemic therapy (approximately 40-60% vs. 10-20%). However, no definite survival benefit has been demonstrated. We have utilized immuno-chemo-combined locoregional therapy to treat liver malignancies, and are convinced that such therapy will bring promising results in liver malignancies for the following reasons: First, the liver is a large immunologic organ and possesses a large amount of lymphocytes/macrophages (Kupffer cells), whose antitumor activities are enhanced in a tumor-bearing state. Our strategy is to anticipate growth inhibition of the tumor and use combined chemotherapy at relatively low doses so as not to impair the anti-tumor activities of the lymphocytes. Moreover, some kinds of chemotherapeutic agents induce immunoaugmentation when low to moderate doses are used. Based on these reasons, we have conducted a pilot study of IL-2-based immunochemotherapy for the treatment of unresectable liver metastases, and have obtained promising results. In this review, we have tried to delineate the locoregional immuno-chemotherapy in liver malignancies at present and future perspectives.