HIMALAYA

HIMALAYA, trial NCT03298451 sponsored by AstraZeneca and reported in 2022, showed that a single priming dose of the CTLA-4 antibody tremelimumab added to durvalumab, the STRIDE regimen, improves survival in first-line unresectable hepatocellular carcinoma compared with sorafenib without needing an anti-VEGF drug. It randomised 1,171 patients, met its primary overall survival endpoint, and its five-year update, the longest follow-up of any phase 3 in liver cancer, showed roughly twice as many long-term survivors with STRIDE, while durvalumab alone was non-inferior to sorafenib. OnCo links it to PD-L1 and CTLA-4 as targets, durvalumab, tremelimumab and Ghassan K. Abou-Alfa, and with no bleeding risk it is usable in patients with varices. The STRIDE plus TACE strategy is being tested in EMERALD-3, and how to choose between STRIDE and atezolizumab plus bevacizumab is the open question.