Advances and challenges in immunotherapy and molecular imaging for hepatocellular carcinoma

Area of Science:

• Oncology
• Immunotherapy
• Molecular Imaging

Background:

• Hepatocellular carcinoma (HCC) is a major cause of cancer death, with advanced stages often unresponsive to standard treatments.
• While targeted combined immunotherapies (Immune Checkpoint Inhibitors with Tyrosine Kinase Inhibitors or anti-VEGF agents) have shown promise, predicting patient response remains challenging due to treatment heterogeneity.
• Identifying reliable predictive biomarkers is crucial for optimizing HCC therapy.

Purpose of the Study:

• To review the current advancements in molecular imaging for assessing the tumor immune microenvironment (TIME) in HCC.
• To evaluate the efficacy of molecular imaging techniques in predicting treatment response to targeted therapies.
• To propose future directions, including AI-multimodal fusion, for enhancing precision oncology in HCC.

Main Methods:

• Comprehensive literature review of molecular imaging modalities (MRI, PET/CT, CT, CEUS) applied to HCC.
• Analysis of studies reporting the use of imaging biomarkers for predicting response to immunotherapy and targeted therapy.
• Synthesis of data on predictive performance, including Area Under the Curve (AUC) values.

Main Results:

• Molecular imaging provides non-invasive insights into the HCC tumor immune microenvironment (TIME).
• Several molecular imaging techniques demonstrated significant predictive capabilities for treatment response, with AUCs exceeding 0.85 in some studies.
• Limitations such as imaging artifacts and the need for standardization were identified.

Conclusions:

• Molecular imaging holds significant potential for stratifying HCC patients and monitoring treatment response.
• AI-multimodal fusion of imaging data presents a promising strategy to overcome current limitations and improve predictive accuracy.
• A roadmap for precision oncology in HCC is proposed, aiming to enhance treatment efficacy and personalization.