Published online Aug 15, 2016. doi: 10.4291/wjgp.v7.i3.242
Peer-review started: April 28, 2016
First decision: June 16, 2016
Revised: July 1, 2016
Accepted: July 20, 2016
Article in press: July 22, 2016
Published online: August 15, 2016
Hepatocellular carcinoma is on the rise and occurs in the setting of chronic liver disease and cirrhosis. Though treatment modalities are available, mortality from this cancer remains high. Medical therapy with the utilization of biologic compounds such as the Food and Drug Administration approved sorafenib might be the only option that can increase survival. Immunotherapy, with modern pharmacologic developments, is a new frontier in cancer therapy and therefore the immunobiology of hepatocarcinogenesis is under investigation. This review will discuss current concepts of immunobiology in hepatocarcinogenesis along with current treatment modalities employing immunotherapy. The tumor microenvironment along with a variety of immune cells coexists and interplays to lead to tumorigenesis. Tumor infiltrating lymphocytes including CD8+ T cells, CD4+ T cells along with regulatory T cells, tumor associated macrophages, tumor associated neutrophils, myeloid derived suppressor cells, and natural killer cells interact to actively provide anti-tumor or pro-tumor effects. Furthermore, oncogenic pathways such as Raf/mitogen-activated protein kinase/extracellular-signal-regulated kinase pathway, phosphatidyl-3-kinase/AKT/mammalian target or rapamycin, Wnt/β-catenin, nuclear factor-κB and signal transducers and activators of transcription 3 may lead to activation and proliferation of tumor cells and are also considered cornerstones in tumorigenesis. Immunotherapy directed at this complex milieu of cells has been showned to be successful in cancer treatment. The use of vaccines, adoptive cell therapy and immune checkpoint inhibitor modulation are current options for therapy. Further translational research will shed light to concepts such as anti-tumor immunity which can add another alternative in the therapeutic armamentarium.
Core tip: Hepatocellular carcinoma is on the rise and is associated with high mortality. Cancer immunology is an expanding field with promise. This review will summarize the current concepts in the immunobiology of hepatocarcinogenesis including the interplay of a variety of immune cells involved in anti-tumor and pro-tumor effects. Oncogenic pathways currently known to effect hepatocarcinogenesis will also be discussed. Finally, currently tested and developed treatment modalities employing immunotherapy will be discussed with an outlook on future therapies.