Natural Killer Cell-Based Immunotherapy in HCC

Hepatocellular carcinoma (HCC) poses a formidable therapeutic challenge due to its high heterogeneity, frequent late-stage diagnosis, and chemoresistance. Natural killer (NK) cells are essential for immune surveillance, yet their quantity and function become significantly compromised during HCC progression, thereby promoting tumour immune escape. This review systematically outlines current NK cell-based immunotherapeutic strategies for HCC, including adoptive NK cell transfer, genetic engineering of NK cells, NK cell inhibitory receptor-targeted therapies, reprogramming of the immunosuppressive HCC microenvironment, cytokine-mediated enhancement of NK cell function, and traditional Chinese medicine-augmented NK cell cytotoxicity. Representing a promising immunotherapeutic paradigm, NK cell-based therapy is rapidly advancing from conventional cell infusion toward more precise modalities, including CAR-NK cells and multifunctional antibody engagers. However, the efficacy of these approaches is frequently curtailed by the immunosuppressive tumour microenvironment and tumour heterogeneity. Given the multifactorial nature of NK cell dysfunction, we highlight that rationally designed combination strategies-integrating genetic engineering, TME reprogramming, and checkpoint blockade-represent the most viable path toward durable clinical responses in HCC.