Four-year overall survival update from the phase III HIMALAYA study of tremelimumab plus durvalumab in unresectable hepatocellular carcinoma

BACKGROUND

In the phase III HIMALAYA study (NCT03298451) in unresectable hepatocellular carcinoma (uHCC), STRIDE (Single Tremelimumab Regular Interval Durvalumab) significantly improved overall survival (OS) versus sorafenib; durvalumab monotherapy was noninferior to sorafenib for OS. Results reported herein are from a 4-year updated OS analysis of HIMALAYA.

PATIENTS AND METHODS

Participants with uHCC and no previous systemic treatment were randomized to STRIDE (n = 393), durvalumab (n = 389), or sorafenib (n = 389). The updated data cut-off was 23 January 2023. OS and serious adverse events (AEs) were assessed. Additionally, baseline characteristics and subsequent therapies were analyzed in long-term survivors (≥36 months beyond randomization).

RESULTS

For STRIDE, durvalumab, and sorafenib, median [95% confidence interval (CI)] follow-up was 49.12 months (46.95-50.17 months), 48.46 months (46.82-49.81 months), and 47.31 months (45.08-49.15 months), respectively. OS hazard ratio (95% CI) for STRIDE versus sorafenib was 0.78 (0.67-0.92). The 36-month OS rate for STRIDE was 30.7% versus 19.8% for sorafenib. The 48-month OS rate remained higher for STRIDE at 25.2%, versus 15.1% for sorafenib. The long-term OS benefit of STRIDE was observed across clinically relevant subgroups and was further improved in participants who achieved disease control. Long-term survivors with STRIDE (n = 103) included participants across clinically relevant subgroups, and 57.3% (59/103) had no reported subsequent anticancer therapy. No new serious treatment-related AEs occurred with STRIDE from the primary analysis (17.5%; 68/388). Durvalumab maintained OS noninferiority to sorafenib and no late-onset safety signals were identified.

CONCLUSIONS

These data represent the longest follow-up to date in phase III studies in uHCC. The unprecedented 3- and 4-year OS rates reinforce the sustained long-term OS benefit of STRIDE versus sorafenib. STRIDE maintained a tolerable yet differentiated safety profile from other current uHCC therapies. Results continue to support the long-term benefits of STRIDE in a diverse population, reflective of uHCC globally.

[MEDICAL TOURISM IN UKRAINE: STATE, PROBLEMS AND PROSPECTS]

Global processes touch on and affect of various spheres and braGlobal processes touch on and affect of various spheres and branches of human activity, including the health sector. «Open» borders facilitate the migration of people around the world. One of the goals of such migration is to obtain medical services. According to the World Health Organization, by 2022, the health and tourism sectors will jointly become one of the world's significant industries, which also will be facilitated by the global tendency of «aging» of the world's population. In recent years, medical tourism accounts for about 2% of world GDP. Development of the sphere of medical services gives rise to the practical need for the legal consolidation of the institution of medical tourism. Due to the fact that the number of people who want to combine rest and treatment is growing rapidly, this situation leads to the consideration of a fairly new sphere in the healthcare industry as medical tourism. The purpose of the study is to analyse the development of medical tourism in Ukraine, identify its problematic theoretical and practical aspects both in the tourist sphere of Ukraine and in the healthcare sector, as well as to search for scientifically-based ways to improve the regulatory and legal mechanism that regulates the activities of medical tourism in Ukraine. To achieve this goal have been investigated the medico-legal nature of medical tourism in Ukraine, an analysis of its implementation in the field of international medical tourism, the mechanisms of its implementation. In Ukraine, have been created public organizations to develop medical tourism as one of the most promising areas of health care, aimed at interacting with Ukrainian and international public and charitable organizations. At the same time, it should be noted that at the initial stage medical tourism needs both legal regulation and state financial support. It is necessary to highlight the subjects of such activities at the legislative level, paying special attention to medical providers, the mechanism of influence on them by the state, their functional responsibilities, which can be organization and support of the patient during travel, the search for clinics and the conclusion of contracts with them for the provision of medical services, conclusion of contracts for the provision of services for transportation, accommodation, insurance. Attracting investors and government funding will allow the restoration of unique medical resorts, clinics and hospitals in the development of reproductive health, spa and rehabilitation treatment; create more favourable conditions for attracting foreign patients.