Neoadjuvant therapy: Dawn of reducing the high post-surgery recurrence rate of hepatocellular carcinoma

Abstract

The high postoperative recurrence rate remains a major challenge in the treatment of hepatocellular carcinoma (HCC) following resection. Increasing research has been delved into investigating the role of neoadjuvant therapy on the prognosis of resectable HCC. Recent trends in combination therapy with molecularly targeted agents and immune checkpoint inhibitors have significantly improved the efficacy of systemic antitumor treatments, yielding survival benefits exceeding 40%. Neoadjuvant therapy for HCC, whether based on systemic antitumor treatments, locoregional therapies, or their combination, has emerged as a promising research direction. However, there remains a matter of debate on neoadjuvant therapy. In this review, we summarize and discuss the research progress and challenges of neoadjuvant therapy for HCC over the past five years from the perspective of Chinese guidelines to provide new insights and future directions in this field.

Keywords: Hepatocellular carcinoma; Neoadjuvant therapy; Locoregional therapy; Molecularly targeted drug; Immune checkpoint inhibitor

Core Tip: Currently, numerous articles focus on preoperative antitumor therapy for hepatocellular carcinoma (HCC). Of note, this review uniquely examines neoadjuvant therapy for HCC within the context of combination therapy from the perspective of the China Liver Cancer Stage. Drawing on the Chinese guidelines, it addresses the definition of the neoadjuvant therapy concept, identifies the target population, evaluates the outcomes of various treatment strategies, and discusses the challenges regarding neoadjuvant therapy for HCC.