| Abstract: | SIGNIFICANCE: Hepatocellular carcinoma (HCC) is a liver malignancy with high mortality rate, limited treatment options and poor prognosis. Sorafenib has been the only systemic treatment option for patients with advanced HCC for more than a decade. While HCC is a typical inflammation-related tumor with distinct immunosuppressive microenvironment especially the up-regulation of immune checkpoints. RECENT ADVANCES: Immunotherapy has shown persistent and powerful efficacy in HCC treatment. Several preclinical and clinical studies have prompted the application of immunotherapy in first-line, second-line and post-line treatment of HCC, which has profoundly shifted the paradigm for advanced HCC treatment in the past few years. CRITICAL ISSUES AND FUTURE DIRECTIONS: Major unaddressed challenges in HCC immunotherapy include the discovery and validation of biological markers that predict the efficacy, the application of immunotherapy in patients with impaired liver function and non-alcoholic steatohepatitis associated-HCC (NASH-HCC), and the exploration of immunotherapy combinations with better effectiveness. This review provides the latest advances in the research of immune microenvironment and immunotherapy in HCC. |
