Targeting gut microbiota in hepatocellular carcinoma: probiotics as a novel therapy

Hepatocellular carcinoma (HCC) or primary liver cancer is the fifth most common cancer, and the third most common cause of cancer-related mortality worldwide with over 700,000 deaths each year (1). HCC commonly occurs in chronically damaged liver tissues due to chronic regenerative and inflammatory processes that contribute to the initiation and/or progression of HCC (2). Eighty to ninety percent of all cases of HCC are linked to cirrhosis or fibrosis, and the well-recognized risk factors are infections with hepatitis C virus (HCV), hepatitis B virus (HBV), alcoholic cirrhosis, as well as hemochromatosis (3). Therapy for HCC is complex and can involve surgical resection, liver transplantation, radiofrequency ablation (RFA) and trans-arterial chemoembolization, radioembolization and emerging systemic chemotherapeutic and targeted agents such as sorafenib. However, tumor relapse, metastasis and chemoresistance are common and thus survival rates in patients with advanced HCC are very low. Therefore, HCC is undoubtedly a disease for which there is an urgent need for the development of alternative therapies