# Advances in the Therapeutic Landscape of Hepatocellular Carcinoma: Current Strategies and Future Perspectives

## TL;DR

This review discusses the evolving treatment strategies for liver cancer, emphasizing personalized approaches and new tools to improve patient outcomes.

## Contribution

The paper provides a comprehensive overview of current and emerging HCC therapies, emphasizing integrated and precision-based treatment strategies.

## Key findings

- Modern HCC care includes curative options, locoregional therapy, and immunotherapy-based systemic regimens.
- Emerging tools like liquid biopsy and radiomics may improve treatment selection and precision in HCC management.

## Abstract

Hepatocellular carcinoma (HCC) arises mostly in chronically diseased livers, so clinicians must manage both an aggressive cancer and a fragile organ simultaneously. This review explains how modern HCC care has evolved into an integrated continuum: from prevention and surveillance to curative options such as resection, ablation, and transplantation, to refined locoregional therapy and immunotherapy-based systemic regimens. We highlight how treatment decisions are tailored according to tumor stage, liver function, portal hypertension, and frailty, and why preserving hepatic reserve is crucial to allow multiple lines of therapy. We also summarize emerging tools such as biomarkers, liquid biopsy, radiomics, and microbiome research that may support more precise treatment selection. Finally, we discuss special populations, safety considerations, and future strategies that combine innovative and traditional approaches to improve survival and quality of life for patients with HCC worldwide. This review aims to guide practical clinical decision-making.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a major cause of cancer mortality worldwide. Because HCC usually arises in cirrhotic livers, prognosis is shaped by the dual threats of tumor progression and hepatic decompensation, requiring treatment decisions that balance anticancer efficacy with preservation of liver function, portal hypertension control, and quality of life. In recent years, management has shifted from a predominantly locoregional approach to an integrated continuum that spans curative resection, ablation, and transplantation; refined transarterial and radiotherapy techniques; and modern systemic therapy dominated by immunotherapy-based combinations. These advances have improved response rates, enabled downstaging and conversion in selected patients, and expanded opportunities for sequential and multimodal treatment. However, challenges persist, including therapeutic decision-making in patients with Child–Pugh B liver function, lack of robust predictive biomarkers, and resistance after initial response. Emerging tools—liquid biopsy, radiomics, AI-assisted imaging, and microbiome modulation—may support future precision strategies and optimized treatment allocation. In this review, we summarize current evidence guiding staging and therapy selection, outline practical considerations across curative, locoregional, and systemic modalities, and discuss evolving biomarkers and next-generation immunotherapy as key steps toward more personalized, durable, and equitable global HCC care.