How does data from the HIMALAYA trial impact your first line treatment selection for advanced HCC?

The results from the HIMALAYA trial with the combination tremelimumab (CTLA-4 inhibitor) and durvalumab (PD-L1 inhibitor) reported an OS of 16.4 months compared to 13.8 months for sorafenib which was statistically significant (HR 0.78, p-value of 0.0035). With the limited data presented at ASCO GI 2...

HIMALAYA was a multicenter, open-label, phase 3 study comparing sorafenib to durvalumab to tremelimumab plus durvalumab in patients with advanced hepatocellular carcinoma who were treatment naïve. The primary objective was overall survival for tremelimumab plus durvalumab (i.e. STRIDE regimen) versu...

Great to have as an option, especially with patients with GI bleeding not correctable with banding (e.g: GAVE).

I will still prefer atezolizumab bevazicumab when it's appropriate. IMbrave150 included ~20% with high risk disease (massive HCC or PVVT4) while HIMALAYA excluded patients with PVV4 from e...

These results should not change anything. Results with Atezo-Bev were superior (including high risk patients excluded in HIMALAYA) and the combination with anti-CTLA4 has more significant toxicity than anti-PD1 and Bevacizumab.

The HIMALAYA study presents a novel therapeutic approach for the treatment of HCC. It presents two treatment advances. 1) The first dual checkpoint inhibitor therapy with improved overall survival as first line therapy for HCC, with 2) only one dose of tremelimumab to be given in a patient's improve...

It is great to have several options in first line treatment of advanced HCC. Purely immune checkpoint inhibitor-based therapy will certainly have an important role in first line management of advanced HCC, especially for patients where there would be increased risk of variceal bleeding or contraindi...

For patients where varices are controlled from risk of bleeding per EGD assessment, I routinely continue to use atezolizumab/bevacizumab as a preferred regimen which is consistent with NCCN guidelines. For patients who cannot receive bevacizumab, there are multiple choices including sorafenib, lenva...

Updated answer - April 29, 2024

Selecting the first-line treatment for advanced hepatocellular carcinoma (HCC) involves considering various factors including the extent of the disease, liver function, patient's overall health/medical comorbidities, and tumor characteristics. I always first consider e...