In the present study, CR was observed in 4 patients (11%) and total response rate was high, representing a satisfactory result. In particular, patients with CR showed a long period of CR and long overall survival. In patients receiving systemic chemotherapy, the rate of achieving CR is supposed to be low at this stage (33). The power

of local control with HAIC thus appears promising. Kemeny et al. reported on the CALGB9481 test, as a randomized prospective trial between Inhibitors,research,lifescience,medical groups receiving HAIC with FUDR and leucovorin compared to systemic chemotherapy with 5-FU and leucovorin (34). Their results showed a significantly longer median survival (24.4 months), longer progression-free survival (9.8 months), Inhibitors,research,lifescience,medical and higher response rate (47%) with HAIC in comparison with systemic chemotherapy. The present results were similar to those described by Kemeny et al., albeit with a higher response rate of 64% (34). This might be attributable to different regimens of chemotherapy. In comparison with the latest systemic chemotherapy, survival and

response rate in our results were not Inhibitors,research,lifescience,medical unfavourable (18,22,33). Although catheter-related problems were emphasized in previous results (29,30) and we also encountered 6 cases with catheter-related complication, HAIC was able to be maintained in 4 cases with replacement of a port or catheter. In comparison with the report by Inhibitors,research,lifescience,medical Kerr et al. (30), the complication rate was low and management was better in our study. When the management of ports and catheters for HAIC was well-organized, the scheduled cycle of administration of HAIC would be achievable in many cases. In terms of severe chemotherapy-related

toxicity, we encountered only 2 patients. Inhibitors,research,lifescience,medical The drug toxicity of HAIC is lower than that of FOLFOX, FOLFIRI or use of molecular-targeted drugs (35). In non-CR cases, tumors eventually progressed and patients died within 4 years. Integrase inhibitor resistance testing Furthermore, CLM with extrahepatic metastases showed very poor prognosis. Additional methods to obtain longer survival are thus necessary in such cases. We Adenosine attempted combination therapy with HAIC and systemic chemotherapy to improve survival in non-CR cases. As HAIC was relatively inexpensive and showed fewer severe side effects compared to FOLFOX or FOLFIRI in our results, the significance of HAIC for controlling liver metastases remains. By combining systemic chemotherapy with HAIC, a well-balanced regime for better quality results may be achieved. Kemeny et al. reported the significance of HAIC with systemic chemotherapy for non-resectable CLM, in combination with oxaliplatin/CPT-11/FUDR. The response rate reached high as 90%, and median survival was long, at 36 months as bove (36). Ducreux et al.