Skip to main content
Log in

Immunotherapy of hepatocellular carcinoma: strategies for combinatorial intervention

  • Review
  • From CAS & CAE Members
  • Published:
Science China Life Sciences Aims and scope Submit manuscript

Abstract

Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer, leading to 74.6 thousand deaths annually. The prognosis of HCC over the last few decades has remained unsatisfactory, and over half of patients with early-stage HCC develop recurrence by the time of follow-up. Immunotherapeutic intervention has emerged as a novel, effective treatment to delay the progression of aggressive tumors and suppress tumor recurrence and metastasis. However, few clinical immunotherapy trials have been conducted in HCC patients, and there is an unmet need for novel therapeutic strategies. The combination of conventional treatments with specific immunotherapeutic approaches may dramatically improve the efficacy of HCC treatment and the clinical outcome of HCC patients. In this review, we briefly summarize immunotherapy strategies and discuss new advances in combined immunotherapeutic approaches for the treatment of patients with liver cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Abou-Alfa, G.K., Meyer, T., Cheng, A.L., El-Khoueiry, A.B., Rimassa, L., Ryoo, B.Y., Cicin, I., Merle, P., Chen, Y.H., Park, J.W., et al. (2018). Cabozantinib in patients with advanced and progressing hepatocellular carcinoma. N Engl J Med 379, 54–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Alnaggar, M., Lin, M., Mesmar, A., Liang, S., Qaid, A., Xu, K., Chen, J., Niu, L., and Yin, Z. (2018). Allogenic natural killer cell immunotherapy combined with irreversible electroporation for stage IV hepatocellular carcinoma: survival outcome. Cell Physiol Biochem 48, 1882–1893.

    Article  CAS  PubMed  Google Scholar 

  • Bollard, J., Miguela, V., Ruiz de Galarreta, M., Venkatesh, A., Bian, C.B., Roberto, M.P., Tovar, V., Sia, D., Molina-Sanchez, P., Nguyen, C.B., et al. (2017). Palbociclib (PD-0332991), a selective CDK4/6 inhibitor, restricts tumour growth in preclinical models of hepatocellular carcinoma. Gut 66, 1286–1296.

    Article  CAS  PubMed  Google Scholar 

  • Brown, S.D., Warren, R.L., Gibb, E.A., Martin, S.D., Spinelli, J.J., Nelson, B.H., and Holt, R.A. (2014). Neo-antigens predicted by tumor genome meta-analysis correlate with increased patient survival. Genome Res 24, 743–750.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Burki, T.K. (2017). Palbociclib improves survival in advanced breast cancer. Lancet Oncol 18, e1.

    Article  PubMed  Google Scholar 

  • Calderaro, J., Rousseau, B., Amaddeo, G., Mercey, M., Charpy, C., Costentin, C., Luciani, A., Zafrani, E.S., Laurent, A., Azoulay, D., et al. (2016). Programmed death ligand 1 expression in hepatocellular carcinoma: relationship with clinical and pathological features. Hepatology 64, 2038–2046.

    Article  CAS  PubMed  Google Scholar 

  • Chen, C.L., Pan, Q.Z., Zhao, J.J., Wang, Y., Li, Y.Q., Wang, Q.J., Pan, K., Weng, D.S., Jiang, S.S., Tang, Y., et al. (2016). PD-L1 expression as a predictive biomarker for cytokine-induced killer cell immunotherapy in patients with hepatocellular carcinoma. Oncoimmunology 5, e1176653.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chen, L.T., Chen, M.F., Li, L.A., Lee, P.H., Jeng, L.B., Lin, D.Y., Wu, C.C., Mok, K.T., Chen, C.L., Lee, W.C., et al. (2012). Long-term results of a randomized, observation-controlled, phase III trial of adjuvant interferon Alfa-2b in hepatocellular carcinoma after curative resection. Ann Surg 255, 8–17.

    Article  PubMed  Google Scholar 

  • Chen, Y., Ramjiawan, R.R., Reiberger, T., Ng, M.R., Hato, T., Huang, Y., Ochiai, H., Kitahara, S., Unan, E.C., Reddy, T.P., et al. (2015). CXCR4 inhibition in tumor microenvironment facilitates anti-programmed death receptor-1 immunotherapy in sorafenib-treated hepatocellular carcinoma in mice. Hepatology 61, 1591–1602.

    Article  CAS  PubMed  Google Scholar 

  • Cui, J., Wang, N., Zhao, H., Jin, H., Wang, G., Niu, C., Terunuma, H., He, H., and Li, W. (2014). Combination of radiofrequency ablation and sequential cellular immunotherapy improves progression-free survival for patients with hepatocellular carcinoma. Int J Cancer 134, 342–351

    Article  CAS  PubMed  Google Scholar 

  • Duffy, A.G., Ulahannan, S.V., Makorova-Rusher, O., Rahma, O., Wedemeyer, H., Pratt, D., Davis, J.L., Hughes, M.S., Heller, T., ElGindi, M., et al. (2017). Tremelimumab in combination with ablation in patients with advanced hepatocellular carcinoma. J Hepatol 66, 545–551.

    Article  CAS  PubMed  Google Scholar 

  • El-Khoueiry, A.B., Sangro, B., Yau, T., Crocenzi, T.S., Kudo, M., Hsu, C., Kim, T.Y., Choo, S.P., Trojan, J., Welling 3rd, T.H., et al. (2017). Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet 389, 2492–2502.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Forner, A., Reig, M., and Bruix, J. (2018). Hepatocellular carcinoma. Lancet 391, 1301–1314.

    Article  PubMed  Google Scholar 

  • Gianni, L., Bisagni, G., Colleoni, M., Del Mastro, L., Zamagni, C., Mansutti, M., Zambetti, M., Frassoldati, A., De Fato, R., Valagussa, P., et al. (2018). Neoadjuvant treatment with trastuzumab and pertuzumab plus palbociclib and fulvestrant in HER2-positive, ER-positive breast cancer (NA-PHER2): an exploratory, open-label, phase 2 study. Lancet Oncol 19, 249–256.

    Article  CAS  PubMed  Google Scholar 

  • Hagel, M., Miduturu, C., Sheets, M., Rubin, N., Weng, W., Stransky, N., Bifulco, N., Kim, J.L., Hodous, B., Brooijmans, N., et al. (2015). First selective small molecule inhibitor of FGFR4 for the treatment of hepatocellular carcinomas with an activated FGFR4 signaling pathway. Cancer Discovery 5, 424–437.

    Article  CAS  PubMed  Google Scholar 

  • Heo, J., Reid, T., Ruo, L., Breitbach, C.J., Rose, S., Bloomston, M., Cho, M., Lim, H.Y., Chung, H.C., Kim, C.W., et al. (2013). Randomized dose-finding clinical trial of oncolytic immunotherapeutic vaccinia JX-594 in liver cancer. Nat Med 19, 329–336.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Horwitz, E., Stein, I., Andreozzi, M., Nemeth, J., Shoham, A., Pappo, O., Schweitzer, N., Tornillo, L., Kanarek, N., Quagliata, L., et al. (2014). Human and mouse VEGFA-amplified hepatocellular carcinomas are highly sensitive to sorafenib treatment. Cancer Discovery 4, 730–743.

    Article  CAS  PubMed  Google Scholar 

  • Inada, Y., Mizukoshi, E., Seike, T., Tamai, T., Iida, N., Kitahara, M., Yamashita, T., Arai, K., Terashima, T., Fushimi, K., et al. (2019). Characteristics of immune response to tumor-associated antigens and immune cell profile in patients with hepatocellular carcinoma. Hepatology 69, 653–665.

    Article  CAS  PubMed  Google Scholar 

  • Janjigian, Y.Y., Bendell, J., Calvo, E., Kim, J.W., Ascierto, P.A., Sharma, P., Ott, P.A., Peltola, K., Jaeger, D., Evans, J., et al. (2018). CheckMate-032 study: efficacy and safety of nivolumab and nivolumab plus ipilimumab in patients with metastatic esophagogastric cancer. J Clin Oncol 36, 2836–2844.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Le, D.T., Durham, J.N., Smith, K.N., Wang, H., Bartlett, B.R., Aulakh, L. K., Lu, S., Kemberling, H., Wilt, C., Luber, B.S., et al. (2017). Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade. Science 357, 409–413.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lee, J.H., Lee, J.H., Lim, Y.S., Yeon, J.E., Song, T.J., Yu, S.J., Gwak, G.Y., Kim, K.M., Kim, Y.J., Lee, J.W., et al. (2015). Adjuvant immunotherapy with autologous cytokine-induced killer cells for hepatocellular carcinoma. Gastroenterology 148, 1383–1391.e6.

    Article  CAS  PubMed  Google Scholar 

  • Lee, J.H., Tak, W.Y., Lee, Y., Heo, M.K., Song, J.S., Kim, H.Y., Park, S.Y., Bae, S.H., Lee, J.H., Heo, J., et al. (2017). Adjuvant immunotherapy with autologous dendritic cells for hepatocellular carcinoma, randomized phase II study. Oncoimmunology 90, e1328335.

    Article  Google Scholar 

  • Liu, C.Q., Xu, J., Zhou, Z.G., Jin, L.L., Yu, X.J., Xiao, G., Lin, J., Zhuang, S.M., Zhang, Y.J., and Zheng, L. (2018). Expression patterns of programmed death ligand 1 correlate with different microenvironments and patient prognosis in hepatocellular carcinoma. Br J Cancer 119, 80–88.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Llovet, J.M., Sala, M., Castells, L., Suarez, Y., Vilana, R., Bianchi, L., Ayuso, C., Vargas, V., Rodes, J., and Bruix, J. (2000). Randomized controlled trial of interferon treatment for advanced hepatocellular carcinoma. Hepatology 31, 54–58.

    Article  CAS  PubMed  Google Scholar 

  • Llovet, J.M., Zucman-Rossi, J., Pikarsky, E., Sangro, B., Schwartz, M., Sherman, M., and Gores, G. (2016). Hepatocellular carcinoma. Nat Rev Dis Primers 2, 16018.

    Article  PubMed  Google Scholar 

  • Long, G.V., Atkinson, V., Lo, S., Sandhu, S., Guminski, A.D., Brown, M.P., Wilmott, J.S., Edwards, J., Gonzalez, M., Scolyer, R.A., et al. (2018). Combination nivolumab and ipilimumab or nivolumab alone in melanoma brain metastases: a multicentre randomised phase 2 study. Lancet Oncol 19, 672–681.

    Article  CAS  PubMed  Google Scholar 

  • Mazzaferro, V., Romito, R., Schiavo, M., Mariani, L., Camerini, T., Bhoori, S., Capussotti, L., Calise, F., Pellicci, R., Belli, G., et al. (2006). Prevention ofhepatocellular carcinoma recurrence with alpha-interferon after liver resection in HCV cirrhosis. Hepatology 44, 1543–1554.

    Article  CAS  PubMed  Google Scholar 

  • Mazzolini, G., Alfaro, C., Sangro, B., Feijoó, E., Ruiz, J., Benito, A., Tirapu, I., Arina, A., Sola, J., Herraiz, M., et al. (2005). Intratumoral injection of dendritic cells engineered to secrete interleukin-12 by recombinant adenovirus in patients with metastatic gastrointestinal carcinomas. J Clin Oncol 23, 999–1010.

    Article  CAS  PubMed  Google Scholar 

  • McGranahan, N., Furness, A.J.S., Rosenthal, R., Ramskov, S., Lyngaa, R., Saini, S.K., Jamal-Hanjani, M., Wilson, G.A., Birkbak, N.J., Hiley, C. T., et al. (2016). Clonal neoantigens elicit T cell immunoreactivity and sensitivity to immune checkpoint blockade. Science 351, 1463–1469.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Motzer, R.J., Tannir, N.M., McDermott, D.F., Aren Frontera, O., Melichar, B., Choueiri, T.K., Plimack, E.R., Barthelemy, P., Porta, C., George, S., et al. (2018). Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma. N Engl J Med 378, 1277–1290.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Murawski, M., Weeda, V.B., Maibach, R., Morland, B., Roebuck, D.J., Zimmerman, A., Casanova, M., Perilongo, G., Laithier, V., Kebudi, R., et al. (2016). Hepatocellular carcinoma in children: does modified platinum- and doxorubicin-based chemotherapy increase tumor resectability and change outcome? lessons learned from the SIOPEL 2 and 3 studies. J Clin Oncol 34, 1050–1056.

    Article  CAS  PubMed  Google Scholar 

  • O’Leary, B., Finn, R.S., and Turner, N.C. (2016). Treating cancer with selective CDK4/6 inhibitors. Nat Rev Clin Oncol 13, 417–430.

    Article  CAS  PubMed  Google Scholar 

  • Qin, S., Bai, Y., Lim, H.Y., Thongprasert, S., Chao, Y., Fan, J., Yang, T.S., Bhudhisawasdi, V., Kang, W.K., Zhou, Y., et al. (2013). Randomized, multicenter, open-label study of oxaliplatin plus fluorouracil/leucovorin versus doxorubicin as palliative chemotherapy in patients with advanced hepatocellular carcinoma from Asia. J Clin Oncol 31, 3501–3508.

    Article  CAS  PubMed  Google Scholar 

  • Rizvi, N.A., Hellmann, M.D., Snyder, A., Kvistborg, P., Makarov, V., Havel, J.J., Lee, W., Yuan, J., Wong, P., Ho, T.S., et al. (2015). Mutational landscape determines sensitivity to PD-1 blockade in non-small cell lung cancer. Science 348, 124–128.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sangro, B., Gomez-Martin, C., de la Mata, M., Inarrairaegui, M., Garralda, E., Barrera, P., Riezu-Boj, J.I., Larrea, E., Alfaro, C., Sarobe, P., et al. (2013). A clinical trial of CTLA-4 blockade with tremelimumab in patients with hepatocellular carcinoma and chronic hepatitis C. J Hepatol 59, 81–88.

    Article  CAS  PubMed  Google Scholar 

  • Sawada, Y., Yoshikawa, T., Ofuji, K., Yoshimura, M., Tsuchiya, N., Takahashi, M., Nobuoka, D., Gotohda, N., Takahashi, S., Kato, Y., et al. (2016). Phase II study of the GPC3-derived peptide vaccine as an adjuvant therapy for hepatocellular carcinoma patients. Oncoimmunology 5, e1129483.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Schulze, K., Imbeaud, S., Letouze, E., Alexandrov, L.B., Calderaro, J., Rebouissou, S., Couchy, G., Meiller, C., Shinde, J., Soysouvanh, F., et al. (2015). Exome sequencing of hepatocellular carcinomas identifies new mutational signatures and potential therapeutic targets. Nat Genet 47, 505–511.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sherr, C.J. (2016). A new cell-cycle target in cancer—inhibiting cyclin D-dependent kinases 4 and 6. N Engl J Med 375, 1920–1923.

    Article  CAS  PubMed  Google Scholar 

  • Shi, L., Lin, H., Li, G., Sun, Y., Shen, J., Xu, J., Lin, C., Yeh, S., Cai, X., and Chang, C. (2016). Cisplatin enhances NK cells immunotherapy efficacy to suppress HCC progression via altering the androgen receptor (AR)-ULBP2 signals. Cancer Lett 373, 45–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Shim, J.H., Jun, M.J., Han, S., Lee, Y.J., Lee, S.G., Kim, K.M., Lim, Y.S., and Lee, H.C. (2015). Prognostic nomograms for prediction of recurrence and survival after curative liver resection for hepatocellular carcinoma. Ann Surg 261, 939–946.

    Article  PubMed  Google Scholar 

  • Sideras, K., Biermann, K., Verheij, J., Takkenberg, B.R., Mancham, S., Hansen, B.E., Schutz, H.M., de Man, R.A., Sprengers, D., Buschow, S. I., et al. (2017). PD-L1, Galectin-9 and CD8+ tumor-infiltrating lymphocytes are associated with survival in hepatocellular carcinoma. Oncoimmunology 6, e1273309.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Simonelli, M., Zucali, P., Santoro, A., Thomas, M.B., de Braud, F.G., Borghaei, H., Berlin, J., Denlinger, C.S., Noberasco, C., Rimassa, L., et al. (2016). Phase I study of PF-03446962, a fully human monoclonal antibody against activin receptor-like kinase-1, in patients with hepatocellular carcinoma. Ann Oncol 27, 1782–1787.

    Article  CAS  PubMed  Google Scholar 

  • Takayama, T., Sekine, T., Makuuchi, M., Yamasaki, S., Kosuge, T., Yamamoto, J., Shimada, K., Sakamoto, M., Hirohashi, S., Ohashi, Y., et al. (2000). Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial. Lancet 356, 802–807.

    Article  CAS  PubMed  Google Scholar 

  • Totoki, Y., Tatsuno, K., Covington, K.R., Ueda, H., Creighton, C.J., Kato, M., Tsuji, S., Donehower, L.A., Slagle, B.L., Nakamura, H., et al. (2014). Trans-ancestry mutational landscape of hepatocellular carcinoma genomes. Nat Genet 46, 1267–1273.

    Article  CAS  PubMed  Google Scholar 

  • Tumeh, P.C., Harview, C.L., Yearley, J.H., Shintaku, I.P., Taylor, E.J.M., Robert, L., Chmielowski, B., Spasic, M., Henry, G., Ciobanu, V., et al. (2014). PD-1 blockade induces responses by inhibiting adaptive immune resistance. Nature 515, 568–571.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ueno, M., Hayami, S., Shigekawa, Y., Kawai, M., Hirono, S., Okada, K., Tamai, H., Shingaki, N., Mori, Y., Ichinose, M., et al. (2015). Prognostic impact of surgery and radiofrequency ablation on single nodular HCC 5 cm: Cohort study based on serum HCC markers. J Hepatol 63, 1352–1359.

    Article  PubMed  Google Scholar 

  • Van Allen, E.M., Miao, D., Schilling, B., Shukla, S.A., Blank, C., Zimmer, L., Sucker, A., Hillen, U., Geukes Foppen, M.H., Goldinger, S.M., et al. (2015). Genomic correlates of response to CTLA-4 blockade in metastatic melanoma. Science 350, 207–211.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wang, H., Liu, A., Bo, W., Feng, X., Hu, Y., Tian, L., Zhang, H., and Tang, X. (2016). Adjuvant immunotherapy with autologous cytokine-induced killer cells for hepatocellular carcinoma patients after curative resection, a systematic review and meta-analysis. Digest Liver Dis 48, 1275–1282.

    Article  CAS  Google Scholar 

  • Yang, Y., Zhou, Y., Hou, J., Bai, C., Li, Z., Fan, J., Ng, I.O.L., Zhou, W., Sun, H., Dong, Q., et al. (2017). Hepatic IFIT3 predicts interferon-α therapeutic response in patients of hepatocellular carcinoma. Hepatology 66, 152–166.

    Article  CAS  PubMed  Google Scholar 

  • Zhou, J., Liu, M., Sun, H., Feng, Y., Xu, L., Chan, A.W.H., Tong, J.H., Wong, J., Chong, C.C.N., Lai, P.B.S., et al. (2018). Hepatoma-intrinsic CCRK inhibition diminishes myeloid-derived suppressor cell immunosuppression and enhances immune-checkpoint blockade efficacy. Gut 67, 931–944.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jia Fan.

Ethics declarations

Compliance and ethics The author(s) declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tian, M., Shi, Y., Liu, W. et al. Immunotherapy of hepatocellular carcinoma: strategies for combinatorial intervention. Sci. China Life Sci. 62, 1138–1143 (2019). https://doi.org/10.1007/s11427-018-9446-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11427-018-9446-2

Navigation