Lee H, et al. - The objective of this study is to explore the general paucity of genomic alteration and low tumor mutation burden in refractory and metastatic hepatoblastoma (HBL). Albeit potentially targetable genomic alterations (GA) is noticed on occasion in HBL and a small number of cases have high tumor mutation burden (TMB) with the potential to respond to immune checkpoint inhibitors, advanced HBL will remain a treatment challenge.