Cancer Genetics and Epigenetics 2024, Vol.12, No.3, 125-136 http://medscipublisher.com/index.php/cge 129 distributions. Overall, the findings highlight the complex interplay between the immune system and tumor cells, offering potential pathways for targeted therapies and improved patient outcomes in HCC. Figure 2 Tumor immune environment in HCC patients (Adopted from Heinrich et al., 2020) Image caption: Transcriptomic profiling allows identification of immune subgroups, identification of processes like clonality and trajectory within T cells as well as identification of different states of activation and exhaustion. Comparison of tumour infiltrating immune cells with cells from non-tumourous sites can identify organ specific immune cell characteristics and gains information about tumour specific influences on its environment (Adopted from Heinrich et al., 2020) 5 Case Studies and Clinical Trials 5.1 Successful implementation Precision treatment for liver cancer has shown promising results in several case studies and clinical trials. For instance, the WINTHER trial demonstrated that genomic and transcriptomic profiling could improve therapy recommendations and patient outcomes. In this trial, patients were navigated to therapy based on DNA sequencing or RNA expression, with a significant proportion showing stable disease or partial/complete response (Malone et al., 2020). Similarly, the I-PREDICT study highlighted the feasibility of personalized treatment with combination therapies, showing that targeting a larger fraction of identified molecular alterations correlated with improved disease control rates and longer progression-free and overall survival rates (Sicklick et al., 2019). Another successful implementation is seen in the study conducted at the Second Hospital of Tianjin Medical University, where genomic-guided individualized precision therapy was effective for a small proportion of patients with refractory metastatic solid tumors, including liver cancer. This study reported that 36.4% of patients showed complete or partial response to the treatment recommendations provided by a molecular tumor board (Wang, 2019). 5.2 Ongoing clinical trials Several ongoing clinical trials are exploring the potential of precision treatment for liver cancer. The IMPACT 2 study is a randomized trial comparing progression-free survival in patients treated based on tumor genomic profiling versus those whose treatment was not selected based on genomic analysis. Preliminary results indicate that precision medicine is associated with favorable outcomes in selected patients (Tsimberidou et al., 2021). Additionally, the LIMORE project has developed a repository of liver cancer cell models to characterize the pharmacogenomic landscape of liver cancers. This project aims to discover gene-drug associations and predictive biomarker candidates for the selection of sorafenib-responding patients, thereby facilitating drug discovery in liver cancers (Figure 3) (Qiu et al., 2019).
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