Efficacy and Safety Outcomes in Combination Immunotherapy for uHCC

This is a video synopsis/summary of a Post-Conference Perspectives featuring Anwaar Saeed, MD; and Amit Singal, MD, MS.

Singal and Saeed discuss the favorable safety profile seen with durvalumab plus tremelimumab in the HIMALAYA trial. The rate of treatment-related adverse events (AEs) is not higher compared to expectations for PD-1/PD-L1 and CTLA-4 combinations. Specifically, about 30% of patients had any-grade immune-related AEs, with 20% requiring high-dose steroids. Importantly, most immune-related AEs occurred within the first 3 months, so the chances of new events decrease during continued therapy for those deriving benefit.

They note durvalumab-tremelimumab avoids the need for VEGF inhibitors and, thus, pretreatment endoscopy to rule out varices, which can be challenging logistically. Singal adds that having even a single episode of an immune-related AE seems to correlate with improved survival outcomes, likely reflecting appropriate immune activation. So these events can be positioned to patients as an indicator that therapy is working, should they opt to continue treatment.

In terms of efficacy comparisons to IMbrave150, the trial populations differed, with more patients with hepatitis B enrolled in IMbrave150. Since this subgroup has better outcomes, it may partially explain the additional 1 month of median survival seen with atezolizumab-bevacizumab. But the impressive 4-year survival rates now reported with durvalumab-tremelimumab reinforce that it represents an equally viable first-line regimen.

Video synopsis is AI-generated and reviewed by OncLive® editorial staff.