Clinical management of liver cancer patients with immune checkpoint inhibitors treatment.

The treatment paradigm of hepatocellular carcinoma (HCC) has evolved with the emergence of immune checkpoint inhibitors (ICIs). Two ICI-based regimens have gained regulatory approval worldwide in unresectable HCC as first line treatment based on the IMBrave150 and HIMALAYA trial. Other regimens such as camrelizumab-rivoceranib and ipilimumab-nivolumab also demonstrated improvement in overall survival as compared to multi-targeted agents in recent phase III clinical trials. With the growing amount of evidence, it is imperative for clinicians to decide the most suitable ICI therapy for each patient based on their disease status and tolerability. Furthermore, ICI in combination with locoregional treatment such as transarterial chemoembolization (TACE) has been shown to prolong the progression-free survival as compared to TACE alone. In early-stage HCC, the role of ICI has been studied in both the adjuvant and neoadjuvant setting. In this narrative review, we will highlight the major advancement of ICI in different stages of HCC and their implication in real world practice. The unmet need in the special population of liver cancer patients and the management of immune-related hepatitis will also be addressed.