# HIMALAYA: tremelimumab plus durvalumab in unresectable hepatocellular carcinoma

Source: https://onco.cc/key-papers/paper-himalaya-nejm-evidence-2022/  
OnCo record `paper-himalaya-nejm-evidence-2022` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A single priming dose of the CTLA-4 antibody tremelimumab followed by durvalumab lengthened survival compared with sorafenib in advanced liver cancer without the bleeding risk of bevacizumab, giving a second first-line immunotherapy standard.

## Summary

Phase 3 trial of 1,171 patients with unresectable hepatocellular carcinoma and no prior systemic therapy randomised to STRIDE (single tremelimumab plus regular durvalumab), durvalumab alone or sorafenib.

Median overall survival was 16.4 months with STRIDE against 13.8 months with sorafenib (hazard ratio 0.78), with three-year survival of 30.7 versus 20.2 percent and durvalumab monotherapy non-inferior to sorafenib; grade 3 to 4 treatment-related adverse events were 25.8 versus 36.9 percent.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: NEJM Evidence
- Year: 2022
- DOI: 10.1056/EVIDoa2100070
- Authors: Abou-Alfa GK, Lau G, Kudo M, et al.
- Findings: Median overall survival 16.4 vs 13.8 months; hazard ratio 0.78.; Three-year overall survival 30.7 percent vs 20.2 percent.
- What it means: Durvalumab-tremelimumab is a first-line standard for advanced hepatocellular carcinoma, particularly for patients with varices or bleeding risk in whom atezolizumab-bevacizumab is unsuitable.
- Caveats: Progression-free survival was not improved, reflecting a subset of long-term responders.; Excluded main portal vein thrombosis.

## Sources

- NEJM Evid 2022: https://doi.org/10.1056/EVIDoa2100070
- PubMed: https://pubmed.ncbi.nlm.nih.gov/38319892/

## Connected records

- cancers: [Advanced hepatocellular carcinoma (BCLC C)](https://onco.cc/cancers/hcc-advanced/), [Intermediate hepatocellular carcinoma (BCLC B)](https://onco.cc/cancers/hcc-intermediate/)
- drugs: [Durvalumab](https://onco.cc/drugs/durvalumab/), [Tremelimumab](https://onco.cc/drugs/tremelimumab/)
- trials: [HIMALAYA](https://onco.cc/trials/himalaya/)
- journals: [NEJM Evidence](https://onco.cc/journals/nejm-evidence/)

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