Many tumor-associated antigens (TAAs) recognized by cytotoxic T cells (CTLs) have been identified during the last two decades and some of them have been used in clinical trials. However, there are very few in the field of immunotherapy for hepatocellular carcinoma (HCC) because there have not been comparative data regarding CTL responses to various TAAs. In the present study, using 27 peptides derived from 14 different TAAs, we performed comparative analysis of various TAA-specific T-cell responses in 31 HCC patients to select useful antigens for immunotherapy and examined the factors that affect the immune responses to determine a strategy for more effective therapy. Twenty-four of 31 (77.4%) HCC patients showed positive responses to at least one TAA-derived peptide in enzymelinked immunospot assay. The TAAs consisting of cyclophilin B, squamous cell carcinoma antigen recognized by T cells (SART) 2, SART3, p53, multidrug resistance-associated protein (MRP) 3, alpha-fetoprotein (AFP) and human telomerase reverse transcriptase (hTERT) were frequently recognized by T cells and these TAA-derived peptides were capable of generating peptide-specific CTLs in HCC patients, which suggested that these TAAs are immunogenic. HCC treatments enhanced TAA-specific immune responses with an increased number of memory T cells and induced de novo T-cell responses to lymphocyte-specific protein tyrosine kinase, human epidermal growth factor receptor type 2, p53, and hTERT. Blocking cytotoxic T-lymphocyte antigen-4 (CTLA-4) resulted in unmasking of TAA-specific immune responses by changing cytokine and chemokine profiles of peripheral blood mononuclear cells stimulated by TAA-derived peptides. Conclusion: Cyclophilin B, SART2, SART3, p53, MRP3, AFP, and hTERT were immunogenic targets for HCC immunotherapy. TAA-specific immunotherapy combined with HCC treatments and anti-CTLA-4 antibody has the possibility to produce stronger tumor-specific immune responses. (HEPATOLOGY 2011;53:1206-1216 H epatocellular carcinoma (HCC) is the most common primary malignancy of the liver and becoming an important public health concern. 1,2 Although many kinds of treatments have been performed for HCC, their effects are limited because the recurrence rate of HCC is very high; therefore, the development of new therapeutic options to prevent recurrence is necessary. 3,4 To protect against recurrence, tumor antigen-specific immunotherapy is an attractive strategy. Many tumorassociated antigens (TAAs) and their epitopes recognized by cytotoxic T cells (CTLs) have been identified during the last two decades and some of them have been used in clinical trials for several cancers. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] The epitopes have been under investigation for the treatment of cancer, with major clinical responses in some trials. 22,23 With regard to immunotherapy for HCC, few kinds of TAAs and their epitopes have been used and only clinical data of a-fetoprotein (AFP) have been reported. 24,25 In human trials targeting AFP, it is...