“Because most patients die from progressive disease in the liver, hepatic arterial infusion pump (HAIP) chemotherapy with floxuridine is an attractive treatment option for unresectable [Intrahepatic cholangiocarcinoma] iCCA. The rationale for HAIP chemotherapy is that iCCA relies mostly on arterial blood supply. Moreover, floxuridine, also known as FUDR, is characterized by its high first-pass effect; approximately 95% is directly metabolized in the liver. Hence, this allows for an up to 400-fold dose increase in subsequent intratumoral exposure compared with systemic treatment, with minimal systemic exposure and side effects”

“HAIP chemotherapy with floxuridine for patients with unresectable iCCA was associated with a favorable 3-year OS of 39.5% compared with systemic chemotherapy where no patients surviving beyond three years were observed in the ABC trials. Even though these results are quite impressive, external validation of these results is necessary besides a randomized controlled trial to optimally determine efficacy.”

Holster, Jessica J et al. “Hepatic Arterial Infusion Pump Chemotherapy for Unresectable Intrahepatic Cholangiocarcinoma: A Systematic Review and Meta-Analysis.” Annals of surgical oncology vol. 29,9 (2022): 5528-5538. Free Full Text.