Transforming Liver Cancer Therapy: Integrating Molecular Profiling with Precision and Transplant-Based Care

Liver cancer, predominantly hepatocellular carcinoma (HCC), remains a leading cause of cancer-related mortality worldwide. Although systemic therapies have advanced in recent years, overall survival remains limited for many patients. A deeper understanding of the molecular and immunological landscape of HCC has driven the emergence of new therapeutic paradigms, from molecularly targeted agents to immune checkpoint blockade. Concurrently, innovations in liver transplantation, liquid biopsy, and multi-omics profiling are reshaping the therapeutic algorithm for selected candidates. This review summarises recent progress in molecular classification, tumour microenvironment mapping, and immune modulation, and examines how these translational insights are redefining clinical practice. Particular emphasis is placed on the integration of molecular markers into transplant eligibility, downstaging strategies, and post-transplant immunosuppression, providing a comprehensive, precision-oriented framework that bridges basic discovery and patient-centred care.