INTRODUCTIONGlobally, hepatocellular carcinoma (HCC) is a major cause of mortality [1,2] . It is the commonest primary liver cancer and accounts for 80%-90% of this class of malignancy. HCC is characterized by a very poor prognosis and is associated with high mortality. Annual mortality from HCC is virtually the same as its annual incidence, attesting to its rapid course and grave prognosis. Moreover, although HCC is the fifth most common cancer worldwide, it is the third most common cause of cancer-related mortality [3] . Recent observations have shown that incidence and mortality from liver cancer in the United States is the fastest growing of all cancers [2] . This is despite a decline in the overall cancer mortality rate that has occurred during the past 20 years. Currently available treatments of HCC are largely inadequate. However, with better understanding of the molecular pathogenesis of the cancer and significant advances in gene silencing technology, improved approaches are being devised to counter the malignancy. In particular, harnessing the RNA interference (RNAi) pathway to inhibit expression of genes that are implicated in transformation of hepatocytes is an exciting new approach to treating HCC. Therapeutic gene silencing technology is however at an early stage of development and there are several important hurdles that need to be overcome before this approach becomes a reality for treating HCC. In this review, we summarize HCC molecular pathogenesis as a background to discussing the interesting prospects of RNAi-based drugs for treating HCC.
CaUses aND mOleCUlaR paThOgeNesIs Of hCCThere are several etiological agents and risk factors that
AbstractPrimary liver cancer is the fifth most common malignancy in the world and is a leading cause of cancer-related mortality. Available treatment for hepatocellular carcinoma (HCC), the commonest primary liver cancer, is rarely curative and there is a need to develop therapy that is more effective. Specific and powerful gene silencing that can be achieved by activating RNA interference (RNAi) has generated enthusiasm for exploiting this pathway for HCC therapy. Many studies have been carried out with the aim of silencing HCC-related cellular oncogenes or the hepatocarcinogenic hepatitis B virus (HBV) and hepatitis C virus (HCV). Proof of principle studies have demonstrated promising results, and an early clinical trial assessing RNAi-based HBV therapy is currently in progress. Although the data augur well, there are several significant hurdles that need to be overcome before the goal of RNAi-based therapy for HCC is realized. Particularly important are the efficient and safe delivery of RNAi effectors to target malignant tissue and the limitation of unintended harmful non-specific effects.