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Page 2 of 3 Feun. Hepatoma Res 2019;5:26 I http://dx.doi.org/10.20517/2394-5079.2019.19

with this unusual anatomy and vasculature. This congenital abnormality represents a challenge for clinical
management and should involve a multidisciplinary team experienced in the treatment of liver cancer.

Dr Ayoub and Dr Jones review the “Impact of nucleos(t)ide analog therapy in hepatitis B on the incidence
[4]
of hepatocellular carcinoma” . Hepatitis B is a major cause of hepatocellular carcinoma worldwide,
particularly in the Far East. This article discusses the role of treatment of hepatitis B, including the new
antiviral agents and how they may reduce but not eliminate the risk of hepatocellular carcinoma. The
third generation nucleos(t)ide analogs, tenofovir and entecavir, which both have a high genetic barrier to
resistance, has led to further decreases in HCC incidence.

Finally, in the article “Immunotherapy for hepatocellular carcinoma: the force awakens in HCC?”, we
[5]
discuss newer therapeutic approaches with immunotherapeutic drugs . It is known that hepatocellular
carcinoma is an inflammation-associated malignancy and so can be immunogenic. Reasons for immune
tolerance are included such as the presence in the liver of myeloid-derived suppressor cells, regulatory
dendritic cells, T regulatory cells, invariant natural killer T- cells, and tumor-associated macrophages.
Furthermore, there is evidence of T-cell exhaustion and apoptosis associated with chronic hepatitis C
infection. Increased expression of TRAIL, indoleamine 2,3-dioxygenase (IDO), and LAG-3 have been
found which may contribute to immunosuppression. In terms of therapy, recently, two checkpoint
inhibitors, nivolumab and pembrolizumab, have been granted conditional approval for the treatment of
hepatocellular carcinoma.

In the 2019 American Society of Clinical Oncology meeting, over 70 abstracts can be found under search
for hepatocellular carcinoma and immunotherapy. Promising early results from clinical trials have been
reported with combination of immunotherapy agents, or other modalities of treatment such as surgery or
[6]
radiation therapy . Thus, immunotherapy can now be considered, along with surgery, radiation therapy
and chemotherapy, as a viable option and offers a new hope for our patients with hepatocellular carcinoma.

DECLARATIONS
Authors’ contributions
Feun LG Contributed solely to the article.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
There is no conflict of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
The author declared that there are no conflicts of interest.

Copyright
© The Author(s) 2019.