Biswas S, Samanta A. Immune therapies in intermediate-advanced unresectable hepatocellular carcinoma: Changing the therapeutic landscape. World J Gastroenterol 2025; 31(14): 103267 [DOI: 10.3748/wjg.v31.i14.103267]
Corresponding Author of This Article
Arghya Samanta, MD, Assistant Professor, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, Uttar Pradesh, India. arghyasamanta2905@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Apr 14, 2025; 31(14): 103267 Published online Apr 14, 2025. doi: 10.3748/wjg.v31.i14.103267
Immune therapies in intermediate-advanced unresectable hepatocellular carcinoma: Changing the therapeutic landscape
Sagnik Biswas, Arghya Samanta
Sagnik Biswas, Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India
Arghya Samanta, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Author contributions: Samanta A designed the overall concept and outline of the manuscript; did literature review and critical revision of the manuscript; Biswas S did the literature review, wrote the initial manuscript draft, contributed to the editing of the manuscript. All authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arghya Samanta, MD, Assistant Professor, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, Uttar Pradesh, India. arghyasamanta2905@gmail.com
Received: November 14, 2024 Revised: March 13, 2025 Accepted: March 19, 2025 Published online: April 14, 2025 Processing time: 148 Days and 17.9 Hours
Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. A substantial proportion of patients are diagnosed with advanced or intermediate-advanced stage disease at presentation and are often ineligible for curative surgery. The mainstay of treatment of this unique intermediate-advanced stage patients who have a liver-limited disease but unresectable due to large tumor burden, number of lesions or technical difficulties, have traditionally been locoregional therapies. However, the response has not been satisfactory in the majority of patients. With the advent of immune therapies and the remarkable progress it has made over the past decade, the management of intermediate-advanced HCC has undergone a paradigm change. Till 2020, sorafenib, a multi-targeted inhibitor of vascular endothelial growth factor, platelet-derived growth factor and rapidly accelerated fibrosarcoma was the one approved immune therapy. However, since 2021, nine more drugs have been approved, based on studies showing improved survival in advanced-stage HCC patients. However, the challenge clinicians face now is to determine the best choice/combination of available drugs to achieve long-term success and survival while maintaining preserved liver function. In light of emerging literature concerning immune therapies, including the relevant randomized controlled trial by Han et al, this editorial aims to review the currently available treatment strategies for the intermediate-advanced stage HCC.
Core Tip: Hepatocellular carcinoma is often identified in advanced cases and is associated with poor survival. Combination therapies such as immune checkpoint inhibitors or tyrosine kinase inhibitors along with interventional therapies are proposed to enhance the sensitivity of these tumors to drug therapy and increasing rates of clinical response. While such an approach has a robust pathophysiological basis, the clinical data on this approach is evolving and needs large multicentric studies. Results from early observational data on combination therapies is encouraging.
