Comparative study of triple intravenous chemotherapy versus dual chemotherapy combined with hepatic arterial infusion in patients with liver metastases from colorectal cancer

Objective: This study aimed to compare the therapeutic efficacy and safety of FOLFOXIRI triplet chemotherapy with FOLFIRI combined with hepatic arterial infusion chemotherapy (HAIC) in patients with unresectable colorectal liver metastases. Methods: This was a single-center retrospective cohort study conducted at the Department of Medical Oncology, The Affiliated Hospital of Yichun University. A total of 132 patients with unresectable colorectal liver metastases treated between January 2019 and December 2023 were included. Patients were divided into the FOLFOXIRI group (n = 67) and the FOLFIRI plus HAIC group (n = 65). The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), objective response rate (ORR), disease control rate (DCR), conversion-to-resection outcomes, and adverse events. Survival outcomes were evaluated using Kaplan-Meier analysis and Cox proportional hazards regression. Results: The FOLFIRI plus HAIC group showed a higher ORR than the FOLFOXIRI group [37/65 (56.9%) vs. 30/67 (44.8%), p = 0.163] and a higher DCR [58/65 (89.2%) vs. 46/67 (68.7%), p = 0.004]. Kaplan-Meier analysis demonstrated significantly longer PFS in the FOLFIRI plus HAIC group than in the FOLFOXIRI group (10.3 vs. 8.2 months; log-rank p = 0.038). In the unadjusted Cox model, FOLFIRI plus HAIC was associated with improved PFS (HR = 0.62, 95% CI, 0.43-0.89; p = 0.009). Median OS was numerically longer in the FOLFIRI plus HAIC group than in the FOLFOXIRI group (19.5 vs. 17.9 months), but the difference was not statistically significant (log-rank p = 0.150; Cox HR = 0.93, 95% CI, 0.61-1.42; p = 0.739). The R0 resection rate was higher in the FOLFIRI plus HAIC group [14/65 (21.5%) vs. 6/67 (9.0%); p = 0.044]. Grade 3/4 adverse events were comparable between groups [20/65 (30.8%) vs. 26/67 (38.8%); p = 0.333], while grade 3/4 neutropenia showed a borderline lower incidence in the FOLFIRI plus HAIC group [12/65 (18.5%) vs. 19/67 (28.4%); p = 0.051]. HAIC-related complications were infrequent and manageable. Conclusions: FOLFIRI plus HAIC was associated with improved disease control, prolonged PFS, and a higher R0 resection rate compared with FOLFOXIRI. The regimen showed a manageable safety profile, with infrequent HAIC-related complications. Given the retrospective and non-randomized design, these findings should be interpreted cautiously and validated in prospective randomized studies.