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Tremelimumab is AstraZeneca's CTLA-4 antibody, given as a single priming dose with durvalumab and chemotherapy in lung and liver cancer.
Tremelimumab is a human IgG2 antibody against CTLA-4, the checkpoint that restrains T-cell priming; a limited number of priming doses alongside a PD-L1 antibody keeps toxicity lower than continuous CTLA-4 blockade. It is used with durvalumab and platinum chemotherapy in first-line metastatic NSCLC without EGFR or ALK alterations, and with durvalumab in unresectable hepatocellular carcinoma. POSEIDON showed tremelimumab plus durvalumab plus chemotherapy improved overall survival versus chemotherapy (HR 0.77), with the largest benefit in STK11/KEAP1/KRAS-mutant and PD-L1-negative disease. Approved November 2022 (NSCLC) and October 2022 (HCC with durvalumab, HIMALAYA). Whether the CTLA-4 component justifies its extra immune toxicity remains debated. For a newcomer, it is the second checkpoint antibody in AstraZeneca's combinations, given briefly to kick-start the immune response.
Backbone ribbon from PDB 5GGV. RCSB PDB 5GGV. The ribbon widens where the chain is folded into a regular pattern and narrows where it is a loose loop.
Human IgG2 anti-CTLA-4; limited priming doses reduce toxicity. Connects to CTLA-4.
1.Tremelimumab binds CTLA-4.
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. Used only in combination with durvalumab.
Covered under the medical benefit with prior authorisation confirming diagnosis, biomarker status and line of therapy; site-of-care policies may steer infusions away from hospital outpatient departments.
20% Part B coinsurance on a high-cost infusion adds up quickly: Medigap Plan G or N, Medicare Advantage maximum out-of-pocket, Medicaid dual eligibility, or a charity fund are the usual buffers.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.
Sources: NICE TA916 · SMC advice: tremelimumab. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
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| Region | Year | Indication |
|---|---|---|
| US | 2022 | Metastatic NSCLC without EGFR/ALK, with durvalumab and platinum chemotherapy; unresectable HCC with durvalumab |
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Patients with limited-stage small-cell lung cancer who complete chemoradiotherapy without progression should now be offered up to two years of durvalumab consolidation, which extends life by almost two years on average. This is the first survival improvement for limited-stage disease since twice-daily radiotherapy and prophylactic cranial irradiation, and small-cell lung cancer is no longer a disease where immunotherapy gives only marginal gains.
Durvalumab-tremelimumab is a first-line standard for advanced hepatocellular carcinoma, particularly for patients with varices or bleeding risk in whom atezolizumab-bevacizumab is unsuitable.
Immunotherapy is now part of first-line treatment for extensive-stage small-cell lung cancer everywhere, on the strength of a gain measured in weeks. The size of that gain is the reason small-cell lung cancer remains the clearest unmet need in thoracic oncology.
Query for this drug: (TITLE:"Tremelimumab" OR ABSTRACT:"Tremelimumab" OR TITLE:"Imjudo" OR ABSTRACT:"Imjudo") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Tremelimumab, not a curated reading list.
Shares EMERALD-3, Intermediate hepatocellular carcinoma (BCLC B), Hepatocellular carcinoma, Immune checkpoint inhibitors.
Shares ADRIATIC: durvalumab after chemoradiotherapy for limited-stage small-cell lung cancer, Limited-stage small-cell lung cancer, Durvalumab, AstraZeneca.
Shares CASPIAN, Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN), Limited-stage small-cell lung cancer, Non-small-cell lung cancer.
Shares HIMALAYA, CTLA-4, Durvalumab, Hepatocellular carcinoma.
Shares Study of Durvalumab + Tremelimumab With Chemotherapy or Durvalumab With Chemotherapy or Chemotherapy Alone for Patients With Lung Cancer (POSEIDON)., CTLA-4, Lung cancer (all types), Immune checkpoint inhibitors.
Shares ADRIATIC: durvalumab after chemoradiotherapy for limited-stage small-cell lung cancer, Durvalumab, AstraZeneca, Lung cancer (all types).
Shares A Study to Investigate the Efficacy of Durvalumab Plus Tremelimumab in Combination With Chemotherapy Compared With Pembrolizumab in Combination With Chemotherapy in Metastatic NSCLC Patients With Non-squamous Histology Who Have Mutations and/or Co-mutations in STK11, KEAP1, or KRAS, Hepatocellular carcinoma (KEGG map), Hepatocellular carcinoma, Lung cancer (all types).
Shares Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN), Lung-MAP (SWOG S1400 and S1900), Limited-stage small-cell lung cancer, Lung cancer (all types).