Tremelimumab for the treatment of hepatocellular carcinoma.

Introduction: Hepatocellular carcinoma (HCC) remains a leading cause of cancer mortality globally. For years, systemic treatment options were limited to tyrosine kinase inhibitors with modest outcomes. The introduction of immunotherapy has transformed the treatment paradigm, establishing immunotherapy as first-line treatment for advanced disease. Among these, tremelimumab -an anti-cytotoxic T-lymphocyte antigen-4 (CTLA-4) antibody- is a key therapeutic agent in the evolving management of HCC.

Areas covered: This review offers a detailed examination of the pharmacological characteristics of tremelimumab and synthesizes evidence from clinical trials assessing its efficacy and safety as both monotherapy and in combination for HCC. It also explores ongoing studies and future perspectives on the role of tremelimumab across diverse stages in the management of HCC.

Expert opinion: Tremelimumab has reshaped the treatment of HCC through its use as a single high-dose priming agent in combination with durvalumab. This approach effectively triggers durable immune responses with a favorable safety profile. Ongoing studies are evaluating its potential in earlier and intermediate stages of HCC, particularly as part of neoadjuvant and conversion therapy strategies. However, the lack of predictive biomarkers specific to tremelimumab remains a key limitation. Future research should focus on identifying patients most likely to benefit from tremelimumab-based combinations.