Evaluating Standardization of Neoadjuvant Immunotherapy in Transplant-Eligible Hepatocellular Carcinoma Populations

In the past decade, immunotherapy has significantly revolutionized the treatment of advanced hepatocellular carcinoma (HCC). Recent phase III trials examining immunotherapy as monotherapy and combination therapy for early to intermediate-stage HCC have produced favorable results, while further phase III trials in this patient cohort are ongoing. Owing to the advantageous data derived from these trials, the utilization of immunotherapy is broadening to include patients with earlier stages of HCC, especially within the transplant-eligible subgroup. Current literature increasingly advocates for the standardized application of neoadjuvant immunotherapy in liver transplantation. Transplantation functions as a potentially curative treatment for HCC and additionally restores normal, healthy liver function. Immunotherapy in pre-transplant patients may improve downstaging efficacy and tumor management, though it carries immunological risks. Immune-related toxicities are substantial in individuals with chronic liver disease, who are particularly susceptible, alongside the risk of acute rejection post-transplantation. The main goal of immunotherapy in this population is to improve access to liver transplantation while preserving pre- and post-transplant results. This concise review analyzes contemporary literature regarding the use of immunotherapy in the neoadjuvant context prior to liver transplantation, explores potential advantages of combination immunotherapy, and synthesizes important recent clinical findings from prominent trials related to HCC transplant oncology treatment.