Preface

**Section 4 Metabolic Impact on Liver Cancer and Alternative**

Chapter 6 **Metabolic Risk Factors in Hepatocellular Carcinoma 97**

Chapter 7 **What Chinese Medicine Can Do for Liver Cancer? 113** Feiyu Chen, Ning Wang and Yibin Feng

Chapter 8 **Interaction of Mitochondrial and Epigenetic Regulation in**

Chapter 9 **Biologic and Immunotherapy Developments in Advanced**

**Section 5 Biology and Immunology of Liver Cancer 137**

**Hepatocellular Carcinoma 139**

**Hepatocellular Carcinoma 159**

Aparicio-Cadena

Andra-Iulia Suceveanu, Laura Mazilu, Andreea-Daniela Gheorghe, Anca Pantea Stoian, Felix Voinea and Adrian-Paul Suceveanu

Victoria Chagoya de Sánchez, Enrique Chávez, Gabriela Velasco-Loyden, María Guadalupe Lozano-Rosas and Alejandro Rusbel

Mohammad Telfah, Mohammed Al-Jumayli and Anwaar Saeed

**Medicine 95**

**VI** Contents

Liver cancer is one of the most common malignancies worldwide and still remains an im‐ portant public health concern. Hepatocellular carcinoma (HCC) is the most prevalent liver cancer. Although several treatments have been implemented for HCC, their therapeutic effi‐ cacy is low and far from overcoming the high recurrence rate of HCC. Therefore, therapy of HCC, particularly the advanced disease, remains a significant unmet clinical need. Howev‐ er, recent advances in immunotherapy using immune check point inhibitors may open a new avenue for HCC treatment.

The majority of patients diagnosed with HCC are elderly people, indicating the vulnerabili‐ ty of the aging population in succumbing to this kind of cancer. Management of HCC in elderly patients is addressed in this book.

HCC originates from hepatocytes, the cells forming the parenchymal tissue of the liver and make up the majority of the liver's mass. Hepatocytes play vital functions in assuming the metabolism of carbohydrates and lipids, protein synthesis, and detoxification from harmful substances. Unfortunately, hepatocytes are subjected to specific viral infections and some products have a high potential to damage liver homeostasis. The factors jeopardizing the normal functions of liver constitute the risk factors for the development of HCC. They inter‐ fere in important biological processes, including epigenetic and immune response. All these points are described in detail in this book.

People chronically infected with both hepatitis B and C present a higher risk for developing HCC. There are ~300–350 million carriers of hepatitis B virus worldwide. For this reason, in this book, we have shown a particular interest in hepatitis B virus.

Currently, many options are available for the treatment of HCC. Potentially curative treat‐ ments like surgical resection or liver transplantation might be possible for less advanced HCC. Those options are discussed in this book. Unfortunately, advanced HCC remains an urgent unmet clinical need. However, novel clinical trials with immune check inhibitors in‐ dicate that new hopes are around the corner for the treatment of advanced HCC. This point is addressed in this book.

Important efforts and collaborations with leading experts in the field were crucial for ach‐ ieving this high-quality book. We thank all the contributors for sharing their expertise, ex‐ pressing their views, and also bringing new hopes for this devastating disease. The readers will appreciate the excellent and reliable information this book offers.

**Ahmed Lasfar**

Member of New Jersey Cancer Institute Faculty Member of Rutgers University at Ernest Mario School of Pharmacy Department of Pharmacology and Toxicology Piscataway, New Jersey

**Section 1**

**Introduction**

**Section 1**
