Dietary Phytochemicals in the Chemoprevention and Treatment of Hepatocellular Carcinoma: In Vivo Evidence, Molecular Targets, and Clinical Relevance

Hepatocellular carcinoma (HCC), one of the most common and lethal cancers, is a growing menace in modern society. Until recently, the majority of detected cases of liver cancer have been found in the developing nations of Asia and Africa; however, its occurrence has significantly increased in the United States. HCC occurs due to several etiologies, such as alcoholism, dietary carcinogens, iron overload, viral hepatitis, as well as several hepatic chronic diseases. In view of the limited treatment options, such as surgery and transplantation, a critical need exists to examine alternative approaches. The use of phytochemicals obtained from dietary sources provides a novel and fascinating preventive and therapeutic approach against HCC. Dietary phytochemicals possess potent antioxidant and anti-inflammatory properties which are extremely critical to combat the significant oxidative stress and inflammation implicated in liver cancer. An impressive number of phytochemicals have shown considerable promise as candidates for the prevention and treatment of HCC. In this article, we systematically review the in vivo pre-clinical evidence documenting the chemopreventive and therapeutic potential of several important dietary phytochemicals in HCC. This review critically examines the molecular mechanisms of the pharmacological effects of the aforementioned animal studies. Clinical and epidemiological studies are also highlighted in this review. Emerging issues such as bioavailability, dose optimization, targeted drug delivery, role of botanical extracts and synergy are also discussed. Finally, current challenges, limitations, future directions, innovative concepts and novel hypotheses for the use of dietary phytochemicals in the chemoprevention and amelioration of human HCC are presented.