The role of metformin as chemopreventive strategies for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most prevalent malignancies globally, while its mortality rate is the second-highest in the world. HCC has mostly been involved by some underlying issues, such as the hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol, and non-alcohol fatty liver disease (NAFLD). Metabolic syndrome and diabetes mellitus currently are independent risk factors to develop HCC in these patients by chronic inflammation and insulin resistance. The next issues following HCC were lack of a good surveillance system, which will result in delayed diagnosis establishment, limited therapeutical option, poor prognosis, and poor survival rates. These problems allow chemoprevention can be a worth to try option in the management of chronic hepatitis patients. Metformin has been known as one of the most often used anti-diabetic agents worldwide and provided many benefits. Based on several recent studies, metformin induces the prevention effect toward the development of HCC with several mechanisms either by the AMPK-dependent or AMPK-independent pathway. In this review article, we will discuss metformin as a promising chemoprevention agent against HCC from mechanisms, current limitations, and future prospects.