[2024 ESMO] '3% 5-Year Survival Rate' Terminal Liver Cancer... Drug That Saves 20% Exists but 'Not Yet in Korea'

AZ Immuno-oncology Drugs 'Imfinzi and Imjudo' Combination Therapy
Proves 20% 5-Year Survival in Terminal Liver Cancer Patients
"Patients Want Long-Term Survival... Unprecedented Data"
"Gently Controls Cancer... Will Use Without Hesitation if Covered"

"The most important goal in liver cancer treatment is improving survival. The combination therapy of Imfinzi and Imjudo (Stride therapy), an immune checkpoint inhibitor that has shown unprecedented data with a 20% five-year survival rate, could be a crucial opportunity to improve survival rates if insurance coverage is applied to provide more options."

Professor Lorenza Rimassa of the Department of Tumor Hematology at Humanitas University in Italy is explaining the importance of the STRIDE therapy at the 2024 European Society for Medical Oncology (ESMO) held in Barcelona, Spain.
[Photo by Lee Chunhee]

Lorenza Rimassa, a world-renowned expert in liver cancer treatment and a professor in the Department of Hematology and Oncology at Humanitas University in Italy, spoke to reporters on the 16th (local time) at the 2024 European Society for Medical Oncology (ESMO) held in Barcelona, Spain. She emphasized that a variety of the latest treatment options must be guaranteed to doctors and patients for the treatment of advanced liver cancer, which is difficult to survive long-term.

Liver cancer is often called the "silent killer" because it usually shows no clear symptoms in the early stages and is often detected only after the cancer has significantly progressed. Especially when cancer cells reach the advanced or metastatic stage, attacking other organs, treatment becomes difficult and survival rates plummet. The five-year relative survival rate for all cancer patients in Korea is about 72.1%, but for liver cancer, it is only about 39.3%, roughly half. The relative survival rate refers to the probability of cancer patients surviving compared to the general population with similar sex and age. If the cancer has metastasized to distant organs such as the brain or lungs, the five-year survival rate drops sharply to 3%.

AstraZeneca's immuno-oncology drug 'Imfinzi'
[Photo by Korea AstraZeneca]

The Stride therapy developed by AstraZeneca (AZ) is the first treatment for advanced liver cancer that uses a dual immune checkpoint inhibitor approach. Cancer cells evade the immune system by creating various fake "passports," such as programmed cell death protein (PD)-L1, pretending to be normal cells. However, immune checkpoint inhibitors neutralize these fake passports, enabling T cells, the soldiers of the immune system, to recognize and attack the cancer. Stride therapy administers Imfinzi, which blocks PD-L1, together with Imjudo, which blocks another fake passport protein called CD80, allowing both immune checkpoint inhibitors to work simultaneously as a dual immunotherapy.

Professor Lorenza Rimassa of the Department of Tumor Hematology at Humanitas University in Italy presented the 5-year overall survival data of the 'Himalaya' study, a Phase 3 clinical trial of the dual immuno-oncology therapy combining Imfinzi and Imjudo (STRIDE regimen) for liver cancer patients, at the 2024 European Society for Medical Oncology (ESMO) held in Barcelona, Spain on the 16th (local time).
[Photo by Chunhee Lee]

At this ESMO conference, it was revealed that unlike existing drugs, which have concerns about toxicity and bleeding side effects, Stride therapy carries relatively lower risks while enabling long-term survival. Three years after treatment initiation, 30.7% of patients treated with Stride therapy survived, compared to 19.9% of patients treated with Nexavar, the existing standard treatment and control group, widening the survival rate gap by more than 10 percentage points. At the five-year mark, the survival rate gap doubled to 19.6% versus 9.4%, and the risk of death was reduced by 24%. Professor Rimassa, the first author leading this study, emphasized, "What patients with advanced liver cancer truly want is to survive longer," adding, "The survival benefit of Stride therapy increases over time, widening the survival rate difference."

Professor Jeon Hong-jae, a leading authority on immunotherapy in Korea and a professor in the Department of Hematology and Oncology at Bundang CHA Hospital, shared the same view, saying, "The biggest expectation when using immunotherapy is that the effect lasts long in patients who respond." He noted that the existing treatment also showed a five-year survival rate of 9%, surpassing the previous 3% survival rate. He interpreted, "Many patients likely received immunotherapy in second- or third-line treatments, and they probably benefited from long-term survival." He added, "Nevertheless, the fact that Stride therapy showed more than double the survival rate difference indicates that the effect of dual immunotherapy in first-line treatment continued."

Professor Jeon Hong-jae of the Department of Hematology and Oncology at Bundang CHA Hospital is explaining the safety of the STRIDE regimen at the 2024 European Society for Medical Oncology (ESMO) held in Barcelona, Spain.
[Photo by Lee Chun-hee]

Both professors emphasized that another reason Stride therapy could prove long-term survival is that it is a "gentle and safe therapy." Professor Jeon explained, "Unlike other cancers, it is important to choose drugs that maintain liver function well in liver cancer," adding, "When cancer progresses, the risk of death increases ninefold, but if liver function deteriorates, that risk rises twentyfold." He said, "It is difficult to be gentle while effectively controlling cancer, but immunotherapy fits this requirement," and interpreted, "Stride therapy is not highly toxic, and long-term data show almost no deterioration in liver function." Professor Rimassa also said, "Patients with a high risk of gastrointestinal bleeding have limited options with existing treatments," adding, "Stride therapy maintained safety during five years of follow-up."

However, although Stride therapy is recommended as the first-line standard treatment for advanced liver cancer by the U.S. National Comprehensive Cancer Network (NCCN) and has been approved domestically, it is not yet covered by the National Health Insurance in Korea. Professor Rimassa said, "Stride therapy is covered by insurance in Italy," and added, "It is very regrettable that a treatment proven to improve five-year survival cannot be used." Professor Jeon also stated, "Before the introduction of Stride therapy, the best option was to use drugs with the lowest possible bleeding risk among risky agents," and suggested the need for insurance coverage, saying, "If insurance coverage is applied, medical staff will be able to use it without much hesitation."