Adriamycin (ADR) is used in the treatment of hepatocellular carcinoma (HCC). HCC frequently occurs in association with cirrhosis of the liver. ADR undergoes an extensive hepatic metabolism and biliary secretion. Therefore ADR elimination could be impaired in patients with HCC. In this study we measured the hepatic extraction of ADR by catheterization of the hepatic veins in five patients with HCC associated with cirrhosis or chronic hepatitis. In all patients the hepatic extraction ratio of ADR was very low (less than 0.10) and in four patients it was 10% or less of that of indocyanin green. This suggests that an impairment of ADR hepatic transport exists in these patients.