Neoadjuvant immunotherapy for resectable primary liver cancer (Review)

Primary liver cancer (PLC) is the third leading cause of cancer-associated mortality worldwide. The most effective curative treatment for liver cancer is radical hepatic resection; however, >50% of patients experience relapse within 2 years. Immune checkpoint inhibitors (ICIs) are effective adjuvant treatments for resectable hepatocellular carcinoma (HCC) following hepatic resection, as they decrease postoperative recurrence risk and prolong patient survival. Clinical trials aim to evaluate the safety and feasibility of neoadjuvant immunotherapy and indicate that ICIs are tolerated and more effective in decreasing local cancer recurrence and metastasis compared with standard neoadjuvant or adjuvant targeted therapies. For resectable intrahepatic cholangiocarcinoma, almost all neoadjuvant therapy regimens involve chemotherapy combined with immunotherapy, but these treatments are available only to those participating in ongoing clinical studies. The present review presents the most relevant efficacy and safety results of completed and ongoing clinical trials and discusses challenges associated with the administration of ICIs for PLC in the neoadjuvant setting. The use of neoadjuvant immunotherapy in patients before liver resection, transplantation, radiofrequency ablation or similar procedures has been investigated primarily through exploratory clinical trials. Neoadjuvant immunotherapy is a promising and safe perioperative treatment for resectable HCC and has acceptable efficacy. Extensive clinical trials with definitive support for this approach are needed to justify its clinical application.