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Feun et al. Hepatoma Res 2017;3:43-51                                Hepatoma Research
           DOI: 10.20517/2394-5079.2016.45
                                                                                                  www.hrjournal.net
            Topic: Novel Approaches for HCC                                                     Open Access

           Immunotherapy for hepatocellular

           carcinoma: the force awakens in HCC?



           Lynn G. Feun, Ying-Ying Li, Medhi Wangpaichitr, Chun-Jing Wu, Niramol Savaraj

           Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA.

           Correspondence to: Prof. Lynn G. Feun, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA.
           E-mail: lfeun@med.miami.edu
           How to cite this article: Feun LG, Li YY, Wangpaichitr M, Wu CJ, Savaraj N. Immunotherapy for hepatocellular carcinoma: the force awakens in
           HCC? Hepatoma Res 2017;3:43-51.

                           Dr. Lynn G. Feun is a Professor of Medicine in Sylvester Comprehensive Cancer Center, University of Miami. He
                           graduated from the Wayne State University School of Medicine in 1974. His clinical and research interests include
                           liver cancer, melanoma, skin cancers, and neuro oncology (primary brain and spine tumors). His specialty is
                           hematology/oncology - internal medicine. Dr. Feun is in the American Board of Internal Medicine and American Board
                           of Internal Med-Medical Oncology. He is also affiliated with Jackson Memorial Hospital and the University of Miami
                           Hospital.




                                         ABSTRACT

            Article history:              Systemic  therapy  for  hepatocellular  carcinoma  (HCC)  has  been  disappointing.  The  only
            Received: 18-11-2016          drug approved by Food and Drug Administration recently has been sorafenib. Sorafenib has
            Accepted: 07-01-2017          modest benefits with a low response rate and an improvement in time to progression of only
            Published: 22-03-2017         2-3 months. Multiple randomized trials, which compare the new agent to sorafenib as either
                                          first line or second line therapy, have been negative, showing no improved clinical benefit.
            Key words:                    Recently, in a large phase III randomized trial, regorafenib has shown superiority to placebo
            Immunotherapy,                as a second line treatment for HCC. However, this drug has multiple side effects and is not
            hepatocellular carcinoma,     well tolerated by many patients. The clinical benefit is also modest. Clearly, new approaches
            sorafenib,                    to treat advanced HCC are still needed. There is data showing that HCC is immunogenic and
            new approaches                the immune system can be stimulated to attack these cancer cells. This article will briefly
                                          review immunotherapy as a promising treatment for HCC.

           INTRODUCTION                                       typically develops in a setting of long standing liver
                                                              cirrhosis. On the other hand, HCC may develop
           There is a strong rationale to evaluate immunotherapy   from HBV even in the absence of liver cirrhosis.
           in this disease. Hepatocellular carcinoma (HCC) is   Increasingly, HCC appears to be developing from
           typically an inflammation-associated cancer and can   nonalcoholic steatohepatitis (NASH) with obesity
           be immunogenic. Both hepatitis B virus (HBV) and   being a risk factor. Studies in mice have shown that
           hepatitis C virus (HCV) are known to be risk factors   dietary factors and genetic obesity can promote liver
           for the development of HCC. The HCC from HCV       inflammation and tumorigenesis. This appears to be
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