# HIMALAYA

Source: https://onco.cc/trials/himalaya/  
OnCo record `himalaya` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A single dose of a CTLA-4 antibody added to PD-L1 blockade doubled five-year survival in liver cancer without needing an anti-VEGF drug.

## Summary

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.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-07
- Registry id: NCT03298451
- Phase: 3
- Setting: First-line unresectable HCC: STRIDE (single priming dose tremelimumab + durvalumab) vs sorafenib
- Sponsor: AstraZeneca
- Enrolled: 1171
- Result: OS HR 0.78; 5-year OS 19.6% vs 9.4%.
- Outcomes: Overall survival: STRIDE 16.4 months vs Sorafenib 13.8 months, HR 0.78; 5-year overall survival: STRIDE 19.6% vs Sorafenib 9.4%, HR 0.76
- Replication: Five-year follow-up of the same trial; the STRIDE + TACE strategy is being tested in EMERALD-3.

## Sources

- ClinicalTrials.gov NCT03298451: https://clinicaltrials.gov/study/NCT03298451
- HIMALAYA 5-year OS (PubMed): https://pubmed.ncbi.nlm.nih.gov/40222621/

## Connected records

- cancers: [Advanced hepatocellular carcinoma (BCLC C)](https://onco.cc/cancers/hcc-advanced/), [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/), [Intermediate hepatocellular carcinoma (BCLC B)](https://onco.cc/cancers/hcc-intermediate/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/)
- targets: [CTLA-4](https://onco.cc/targets/ctla4/), [PD-L1](https://onco.cc/targets/pdl1/)
- drugs: [Durvalumab](https://onco.cc/drugs/durvalumab/), [Tremelimumab](https://onco.cc/drugs/tremelimumab/)
- companies: [AstraZeneca](https://onco.cc/companies/astrazeneca/)
- people: [Ghassan K. Abou-Alfa](https://onco.cc/people/ghassan-abou-alfa/)
- pairings: [Caution: bevacizumab-based regimens with untreated varices](https://onco.cc/pairings/io-varices-caution/)
- key papers: [HIMALAYA: tremelimumab plus durvalumab in unresectable hepatocellular carcinoma](https://onco.cc/key-papers/paper-himalaya-nejm-evidence-2022/)

---
JSON: https://onco.cc/api/v1/entities/himalaya.json