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Imfinzi plus Imjudo demonstrated unprecedented overall survival in advanced liver cancer with one in five patients surviving five years in HIMALAYA Phase III trial

Published

2 år ago

16 september, 2024

Tanalys

Longest survival follow-up ever reported for a Phase III immunotherapy trial in this setting.

Updated results from the HIMALAYA Phase III trial showed AstraZeneca’s Imfinzi (durvalumab) plus Imjudo (tremelimumab) demonstrated a sustained, clinically meaningful overall survival (OS) benefit at five years for patients with unresectable hepatocellular carcinoma (HCC) who had not received prior systemic therapy and were not eligible for localised treatment.

These results from HIMALAYA will be presented today at the European Society for Medical Oncology (ESMO) Congress 2024 in Barcelona, Spain (presentation 947MO).

At five years of follow-up, this latest exploratory analysis showed that a single priming dose of Imjudo added to Imfinzi, called the STRIDE regimen (Single Tremelimumab Regular Interval Durvalumab), reduced the risk of death by 24% compared to sorafenib (based on a hazard ratio [HR] of 0.76; 95% confidence interval [CI] 0.65-0.89). An estimated 19.6% of patients treated with the STRIDE regimen were alive at five years versus 9.4% of those treated with sorafenib.

In a subgroup analysis of patients in the trial who achieved disease control, defined as complete or partial response or stable disease, 28.7% of those treated with the STRIDE regimen were alive at five years versus 12.7% of patients treated with sorafenib. In addition, an exploratory analysis of depth of response (DpR) showed that more patients treated with the STRIDE regimen experienced deep responses leading to longer survival compared to sorafenib.

Lorenza Rimassa, MD, Associate Professor of Medical Oncology, Humanitas University and IRCCS Humanitas Research Hospital, Milan, Italy and a lead investigator in the HIMALAYA trial, said: “Treatment with durvalumab plus tremelimumab for patients with advanced liver cancer doubled the overall survival rate at five years, a significant survival advantage over sorafenib that has also become even more pronounced over time. These data reinforce the use of this novel dual immunotherapy regimen and are an important milestone for patients with this devastating disease.”

Sarah Manes, Liver Cancers Program Director at Global Liver Institute, said: “Reaching the five-year survival milestone is both clinically significant and emotionally meaningful for people with advanced liver cancer and their families. We are thrilled to see this progress in improving outcomes with new treatment options, bringing new hope for long-term survivorship to patients in our community.”

Susan Galbraith, Executive Vice President, Oncology R&D, AstraZeneca, said: “It is remarkable to see nearly 20 per cent of patients with advanced liver cancer treated with the STRIDE regimen alive at five years compared to only about seven per cent of patients living that long historically. This is a major step forward, setting a new survival benchmark. This underscores our commitment to following patients for the long term to help us better characterise the enduring clinical benefits of this innovative priming approach with an anti-CTLA-4 antibody added to PD-L1 blockade.”

Summary of updated survival results: HIMALAYA

OS^{i, ii}	STRIDE(n=393)	Sorafenib (n=389)
Median duration of follow-up, in months (95% CI)	62.5 (59.5-64.8)	59.9 (58.3-61.5)
OS HR (95% CI)	0.76 (0.65-0.89)
p-value (2-sided)ⁱⁱⁱ	0.0008
OS rate^iv at 60 months (95% CI), %	19.6	9.4
DC at 60 monthsNumber of patientsOS rate, %	4328.7	1712.7
DpR^v >75% at 60 monthsNumber of patientsOS rate^iv, %	2772.7	333.3
DpR^v >50%–≤75% at 60 monthsNumber of patientsOS rate^iv, %	3457.8	1232.1
i. Updated analysis data cut-off: 01 March 2024, with 82% OS data maturityii. OS HRs and 95% CIs were calculated using a Cox proportional hazards model adjusting for treatment, aetiology, ECOG performance status, and macrovascular invasion iii. Nominal p-valueiv. OS rates at 60 months were estimated using Kaplan-Meier methodv. DpR represents the percentage of tumor shrinkage from baseline observed at the time of best objective response evaluation

The safety profile of the STRIDE regimen was consistent with the known profiles of each medicine, and no new safety signals were observed with longer follow-up. Serious treatment-related adverse events, defined as Grade 3 or 4 and including death, were experienced by 17.5% of patients treated with the STRIDE regimen versus 9.9% of patients treated with sorafenib, with no new events occurring after the primary analysis for STRIDE.

Imfinzi in combination with Imjudo is approved for the treatment of adults with advanced or unresectable HCC in the US, EU (in the 1st-line setting), Japan and several other countries. Imfinzi monotherapy is also approved in Japan in this setting.

Notes

Liver cancer
Liver cancer, of which HCC is the most common type, is the third-leading cause of cancer death, with nearly 900,000 people worldwide diagnosed each year and a high prevalence in certain regions of Asia.^1-2 An estimated 80-90% of all patients with HCC also have cirrhosis. Chronic liver diseases such as cirrhosis are associated with inflammation that over time can lead to the development of HCC.³

Advanced-stage HCC prognosis is poor, with a five-year survival rate of only 7%.⁴More than half of patients are diagnosed at advanced stages of the disease, often when symptoms first appear.⁵ The unique immune environment of liver cancer provides clear rationale for investigating medications that harness the power of the immune system to treat HCC.⁵

HIMALAYA
HIMALAYA is a randomised, open-label, multi-centre, global Phase III trial of Imfinzi monotherapy and a regimen comprising a single priming dose of Imjudo 300mg added to Imfinzi 1500mg followed by Imfinzi every four weeks (STRIDE regimen) versus sorafenib, a standard-of-care multi-kinase inhibitor.

The trial included a total of 1,324 randomised patients with unresectable, advanced HCC who had not been treated with prior systemic therapy and were not eligible for locoregional therapy (treatment localised to the liver and surrounding tissue).

The trial was conducted in 181 centres across 16 countries, including in the US, Canada, Europe, South America and Asia. The primary endpoint was OS for the combination versus sorafenib and key secondary endpoints included OS for Imfinzi versus sorafenib, objective response rate and progression-free survival (PFS) for the combination and for Imfinzi alone.

Imfinzi

Imfinzi (durvalumab) is a human monoclonal antibody that binds to the PD-L1 protein and blocks the interaction of PD-L1 with the PD-1 and CD80 proteins, countering the tumour’s immune-evading tactics and releasing the inhibition of immune responses.

Imfinzi is approved in combination with chemotherapy (gemcitabine plus cisplatin) in locally advanced or metastatic biliary tract cancer (BTC) and in combination with Imjudo (tremelimumab) in unresectable HCC. Imfinzi is also approved as a monotherapy in unresectable HCC in Japan and the EU and in combination with chemotherapy (carboplatin plus paclitaxel) followed by Imfinzi monotherapy in primary advanced or recurrent endometrial cancer that is mismatch repair deficient in the US.

In addition to its indications in gastrointestinal (GI) cancers, Imfinzi is the global standard of care in the curative-intent setting of unresectable, Stage III non-small cell lung cancer (NSCLC) in patients whose disease has not progressed after chemoradiotherapy. Imfinzi is also approved for the treatment of extensive-stage small cell lung cancer (SCLC) and in combination with a short course of Imjudo and chemotherapy for the treatment of metastatic NSCLC. In limited-stage SCLC, Imfinzi demonstrated statistically significant and clinically meaningful improvements in the dual primary endpoints of OS and PFS compared to placebo in patients who had not progressed following standard-of-care concurrent chemoradiotherapy in the ADRIATIC Phase III trial.

Imfinzi in combination with neoadjuvant platinum-containing chemotherapy before surgery and as adjuvant monotherapy after surgery has been approved for patients in the US and several other countries for the treatment of adult patients with resectable NSCLC and no known epidermal growth factor receptor mutations or anaplastic lymphoma kinase rearrangements.

Imfinzi plus chemotherapy followed by Imfinzi alone was recently approved in the US for mismatch repair deficient patients with primary advanced or recurrent endometrial cancer. This regimen was also approved in the EU, in addition to Imfinzi plus chemotherapy followed by Imfinzi and Lynparza (olaparib) for mismatch repair proficient patients.

In muscle-invasive bladder cancer, Imfinzi in combination with chemotherapy demonstrated a statistically significant and clinically meaningful improvement in the primary endpoint of event-free survival and the key secondary endpoint of OS versus neoadjuvant chemotherapy in the NIAGARA Phase III trial.

Since the first approval in May 2017, more than 220,000 patients have been treated with Imfinzi. As part of a broad development programme, Imfinzi is being tested as a single treatment and in combinations with other anti-cancer treatments for patients with SCLC, NSCLC, bladder cancer, breast cancer, several GI and gynaecologic cancers and other solid tumours.

Imjudo
Imjudo (tremelimumab) is a human monoclonal antibody that targets the activity of cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). Imjudo blocks the activity of CTLA-4, contributing to T-cell activation, priming the immune response to cancer and fostering cancer cell death. In addition to its approved indications in liver and lung cancers, Imjudo is being tested in combination with Imfinzi across multiple tumour types including locoregional HCC (EMERALD-3), SCLC (ADRIATIC) and bladder cancer (VOLGA and NILE).

AstraZeneca in GI cancers

AstraZeneca has a broad development programme for the treatment of GI cancers across several medicines and a variety of tumour types and stages of disease. In 2022, GI cancers collectively represented approximately 4.9 million new cancer cases leading to approximately 3.3 million deaths.⁶

Within this programme, the Company is committed to improving outcomes in gastric, liver, biliary tract, oesophageal, pancreatic and colorectal cancers.

In addition to its indications in BTC and HCC, Imfinzi is being assessed in combinations, including with Imjudo, in liver, oesophageal and gastric cancers in an extensive development programme spanning early to late-stage disease across settings.

The Company is also assessing rilvegostomig (AZD2936), a PD-1/TIGIT bispecific antibody, in combination with chemotherapy as an adjuvant therapy in BTC and as a 1st-line treatment in patients with HER2-negative, locally advanced unresectable or metastatic gastroesophageal junction cancers.

Enhertu (trastuzumab deruxtecan), a HER2-directed antibody drug conjugate, is approved in the US, China and several other countries for HER2-positive advanced gastric cancer and is being assessed in colorectal cancer. It also has been assessed in multiple GI settings including BTC in the DESTINY-PanTumor02 Phase II trial, and it was recently approved in the US for the treatment of unresectable or metastatic HER2-positive solid tumours who have received prior systemic treatment and have no satisfactory alternative treatment options. Enhertu is jointly developed and commercialised by AstraZeneca and Daiichi Sankyo.

Lynparza (olaparib), a first-in-class PARP inhibitor, is approved in the US, EU and several other countries for the treatment of BRCA-mutated metastatic pancreatic cancer. Lynparza is developed and commercialised in collaboration with MSD (Merck & Co., Inc. inside the US and Canada).

AstraZeneca is advancing multiple modalities that provide complementary mechanisms for targeting Claudin 18.2, a promising therapeutic target in gastric cancer. These include AZD0901, a potential first-in-class antibody drug conjugate licensed from KYM Biosciences Inc., currently in Phase III development; AZD5863, a novel Claudin 18.2/CD3 T-cell engager bispecific antibody licensed from Harbour Biomed in Phase I development; and AZD6422, an armoured autologous chimeric antigen receptor T cell (CAR-T) therapy, currently being evaluated in an Investigator Initiated Trial (IIT) in collaboration with AbelZeta in China.

In early development, AstraZeneca is developing two Glypican 3 (GPC3) armoured CAR-Ts in HCC. AZD5851, currently in Phase I development, is being developed globally, and C-CAR031 / AZD7003 is being co-developed with AbelZeta in China where it is under evaluation in an IIT.

AstraZeneca in immuno-oncology (IO)

AstraZeneca is a pioneer in introducing the concept of immunotherapy into dedicated clinical areas of high unmet medical need. The Company has a comprehensive and diverse IO portfolio and pipeline anchored in immunotherapies designed to overcome evasion of the anti-tumour immune response and stimulate the body’s immune system to attack tumours.

AstraZeneca strives to redefine cancer care and help transform outcomes for patients with Imfinzi as a monotherapy and in combination with Imjudo as well as other novel immunotherapies and modalities. The Company is also investigating next-generation immunotherapies like bispecific antibodies and therapeutics that harness different aspects of immunity to target cancer, including cell therapy and T-cell engagers.

AstraZeneca is pursuing an innovative clinical strategy to bring IO-based therapies that deliver long-term survival to new settings across a wide range of cancer types. The Company is focused on exploring novel combination approaches to help prevent treatment resistance and drive longer immune responses. With an extensive clinical programme, the Company also champions the use of IO treatment in earlier disease stages, where there is the greatest potential for cure.

AstraZeneca in oncology

AstraZeneca is leading a revolution in oncology with the ambition to provide cures for cancer in every form, following the science to understand cancer and all its complexities to discover, develop and deliver life-changing medicines to patients.

The Company’s focus is on some of the most challenging cancers. It is through persistent innovation that AstraZeneca has built one of the most diverse portfolios and pipelines in the industry, with the potential to catalyse changes in the practice of medicine and transform the patient experience.

AstraZeneca has the vision to redefine cancer care and, one day, eliminate cancer as a cause of death.

AstraZeneca

AstraZeneca (LSE/STO/Nasdaq: AZN) is a global, science-led biopharmaceutical company that focuses on the discovery, development, and commercialisation of prescription medicines in Oncology, Rare Diseases, and BioPharmaceuticals, including Cardiovascular, Renal & Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca’s innovative medicines are sold in more than 125 countries and used by millions of patients worldwide. Please visit astrazeneca.com and follow the Company on social media @AstraZeneca.

Contacts

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References

World Health Organization. Liver Cancer Fact Sheet. Available at: https://gco.iarc.who.int/media/globocan/factsheets/cancers/11-liver-and-intrahepatic-bile-ducts-fact-sheet.pdf. Accessed September 2024.
Liu Y, et al. Changes in the Epidemiology of Hepatocellular Carcinoma in Asia. Cancers (Basel). 2022;14(18):4473.
Tarao K, et al. Real impact of liver cirrhosis on the development of hepatocellular carcinoma in various liver diseases—meta‐analytic assessment. Cancer Med. 2019;8(3):1054-1065.
Sayiner M, et al. Disease Burden of Hepatocellular Carcinoma: A Global Perspective. Digestive Diseases and Sciences. 2019;64: 910-917.
Colagrande S, et al. Challenges of advanced hepatocellular carcinoma. World J Gastroenterol. 2016;22(34):7645-7659.
World Health Organization. Cancer factsheets: Digestive organs (oesophagus, anus, stomach, colon, rectum, liver and intrahepatic bile ducts, pancreas, gallbladder). Available at: https://gco.iarc.fr/today/en/fact-sheets-cancers. Accessed September 2024.

Marknadsnyheter

Investerarens guide till säljtratten: Varför intäkter är en laggande indikator

Published

2 veckor ago

4 juni, 2026

Skribent

Som investerare eller trader är du van vid att leta efter mönster och indikatorer som kan förutsäga framtida prisrörelser. Inom teknisk analys (TA) skiljer vi noga på ledande indikatorer (som ger signaler innan en trend vänder) och laggande indikatorer (som bekräftar en rörelse som redan skett). Samma obarmhärtiga logik gäller när vi analyserar fundamentan och tillväxtpotentialen i B2B-bolag.

När kvartalsrapporten släpps stirrar marknaden sig ofta blind på omsättningstillväxt och sista raden. Men sanningen är att dagens intäkter är den ultimata laggande indikatorn. Den omsättning ett B2B-bolag redovisar idag är resultatet av sälj- och marknadsaktiviteter som genomfördes för sex, nio eller tolv månader sedan. Att köpa en aktie enbart baserat på historisk omsättning är som att handla ett index baserat enbart på ett glidande medelvärde – du agerar på gammal information.

För att verkligen förstå ett bolags framtida kassaflöden och fundamentala styrka måste du titta på toppen av deras säljtratt. Det är där de ledande indikatorerna finns.

Säljpipelinen som ledande indikator

Ett bolags säljpipeline (det samlade värdet av alla pågående affärsmöjligheter) är i teorin den bästa ledande indikatorn för framtida intäkter. Om pipelinen växer idag, bör intäkterna växa imorgon. Men precis som i teknisk analys är inte alla signaler tillförlitliga. Marknaden är full av ”falska utbrott” och ”bull traps”.

Många bolag pumpar upp sin pipeline med orealistiska affärsmöjligheter för att lugna styrelsen eller marknaden. Säljarna lägger in företag som visat ett vagt intresse, men som saknar budget eller mandat att fatta beslut. Detta skapar en illusion av framtida tillväxt.

När ledningen styr bolaget efter denna uppblåsta pipeline – man kanske anställer mer leveranspersonal eller drar på sig fasta kostnader i tron att intäkterna är på väg – och affärerna sedan inte materialiseras, slår det skoningslöst mot marginalerna nästa kvartal. En ostrukturerad pipeline är lika farlig som felkalibrerad algoritm; ”Garbage in, garbage out”.

Att skapa en sann signal

Hur bygger ett företag en pipeline som faktiskt utgör en sann signal för framtida intäkter? Svaret ligger i hur inflödet av nya affärsmöjligheter hanteras och filtreras i det allra första ledet.

För att eliminera bruset måste bolag etablera rigorösa processer i toppen av tratten. Detta innebär att sluta mäta fåfänga mätetal som ”antal samtal” och istället fokusera på konverteringskraft och relevans. Genom att integrera professionell och kvalificerad mötesbokning säkerställer företaget att endast de prospekt som har ett faktiskt affärsbehov, rätt beslutsfattare och finansiella muskler tillåts komma in i säljpipelinen.

När denna filtrering sköts med strategisk precision, förvandlas pipelinen från en lista med förhoppningar till en matematisk sannolikhetskalkyl. Det är detta som skiljer bolag med hög volatilitet i sina intäkter från bolag med en förutsägbar, maskinell tillväxt.

Värderingsmultipeln och förutsägbarhet

Varför är detta kritiskt ur ett investerarperspektiv? Finansmarknaden, oavsett om det handlar om börsen, Private Equity eller riskkapital, avskyr osäkerhet och älskar förutsägbarhet.

Ett bolag vars intäkter bygger på en handfull ”stjärnsäljares” ostrukturerade nätverkande bär på en enorm operativ risk. Deras intäkter kommer att vara volatila. Å andra sidan, ett bolag som har byggt en kommersiell arkitektur där de exakt vet hur stor bearbetningsinsats som krävs för att generera en viss intäkt i framtiden, premieras alltid.

Dessa bolag handlas till högre multiplar (P/E eller EV/EBITDA) just för att deras kassaflöden har en lägre riskpremie. Som investerare eller analytiker bör du därför alltid ställa dig frågan: Hur ser maskineriet ut innan affären ens blir en siffra i kvartalsrapporten? Det är där du hittar bolagets sanna momentum.

Marknadsnyheter

Slutet för 10-årsavtalen: Flexibla kontor som företagets krisberedskap

Published

2 veckor ago

3 juni, 2026

Skribent

Under det senaste decenniets dopade ekonomi, drivet av nollräntor och billigt kapital, byggde många företag upp enorma fasta kostnader. Det var en era präglad av hybris där bolag glatt signerade 5- eller 10-åriga kommersiella hyreskontrakt för prestigefyllda kontorslandskap, i tron att tillväxten var linjär och evig. Sedan kom räntechocken, inflationen och den geopolitiska oron.

När vi idag diskuterar krisberedskap och resiliens inom näringslivet (”business prepping”) handlar det inte bara om att bygga en likviditetsbuffert för sämre tider. Det handlar om att systematiskt eliminera fasta kostnader och skapa maximal operativ agilitet. I det perspektivet har det traditionella kontorsavtalet förvandlats från en trygghet till en massiv finansiell risk – en regelrätt ”Single Point of Failure” (SPOF) i företagets balansräkning.

Den statiska hyreskostnaden som en SPOF

Det traditionella kommersiella fastighetsmaskineriet bygger på att överföra risk från fastighetsägaren till hyresgästen. Företag låser in sig i långa, oflexibla avtal som indexuppräknas årligen. Om marknaden viker och bolaget måste minska sin personalstyrka med trettio procent, sitter de fortfarande fast med samma enorma overheadkostnad för ekar tomma kvadratmeter.

I en stagnerande eller volatil makroekonomi är kostnadselasticitet – förmågan att omedelbart kunna skala upp eller ner sina utgifter i takt med intäkterna – skillnaden mellan överlevnad och konkurs. Att binda upp framtida kassaflöden i ett decennium för att förvara skrivbord är helt enkelt inte rationell riskhantering längre.

Affärsmässig prepping och ”Space-as-a-Service”

Detta är den fundamentala drivkraften bakom skiftet från traditionella kontor till flexibla kontorshotell och coworking-hubbar (”Space-as-a-Service”). För ett framåtblickande företag är detta ett led i sin strategiska krisberedskap.

Genom att sitta på ett modernt kontorshotell köper bolaget sig friheten att vara agil. Växer företaget snabbt kan man addera fler rum över en natt. Slår en recession till och personalstyrkan måste bantas, kan företaget minska sin kontorsyta med en månads varsel. Kostnaden rör sig därmed i perfekt symbios med företagets aktuella behov och ekonomiska bärkraft, istället för att vara en stel kvarnsten runt halsen.

Delningsekonomi för minimerad overhead

Den andra aspekten av denna riskminimering handlar om resursutnyttjande. En stor del av den dyra kvadratmeterytan i traditionella kontor består av receptioner, lounger, kök och stora styrelserum – ytor som står ekande tomma uppåt 80 procent av arbetsveckan, men som företaget likväl betalar fullt pris för varje månad.

På ett kontorshotell delas denna infrastruktur. Företaget betalar enbart för sin kärnyta. När ledningsgruppen väl behöver stänga in sig för kvartalsplanering, eller när det är dags att samla kunder och partners, betalar man inte för ett ständigt tomt representationsrum. Istället nyttjar man delad infrastruktur och bokar en konferens i Malmö exakt de dagar behoven uppstår. Kostnaden blir en tillfällig, rörlig utgift i stället för en permanent, fast overhead.

Flexibilitet är den nya tryggheten

Illusionen av att ett eget, stort och fast kontor är ett tecken på stabilitet är borta. I dagens makroekonomiska klimat är stabilitet synonymt med flexibilitet.

Företag som strategiskt undviker långa inlåsningseffekter skyddar sina marginaler, säkrar sitt kassaflöde och behåller manöverutrymmet oavsett vad som händer med räntan, inflationen eller konjunkturen. Att flytta verksamheten till en flexibel hubb är inte bara en kontorsfråga – det är modern, ekonomisk krishantering.

Marknadsnyheter

Nordtech gör en IPO på Stockholmsbörsen

Published

2 veckor ago

3 juni, 2026

Skribent

Nordtech har pratat om en IPO redan för några år sedan och på senare tid har mjukvarubolag tagit stryk på grund av rädslan för AI. Men Nordtech låter sig inte avskräckas utan tror på det man gör. Tre miljarder kronor kommer företaget att vara värt, dvs det är vad post money-värderingen kommer att vara efter IPO-erbjudandet.

Erbjudande backas upp av flera välkända namn så vi kan räkna med att den här börsnoteringen kommer att gå i mål på ett helt galant sätt.

I skrivande stund har ännu ingen analytiker kommit ut med en rekommendation så det ska bli intressant att se vad de säger, även om det känns som att det kommer att vara tecknarekommendationer.

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