编者按:2026年欧洲肿瘤内科学会(ESMO)年会于西班牙举办,大会汇聚全球肿瘤领域专家学者,分享多项肝胆肿瘤领域重磅更新,为肝细胞癌(HCC)的临床诊疗带来全新思考。HIMALAYA研究确立了STRIDE方案在晚期HCC一线治疗中的重要地位,而意大利Humanitas大学及Humanitas研究医院Lorenza Rimassa教授在本次大会公布的7年超长随访总生存数据,进一步刷新了我们对晚期肝癌长期生存的认知。本刊特邀Lorenza Rimassa教授,围绕这项重磅研究的全新数据展开深度访谈,探讨肿瘤缓解指标对长期生存的预判价值、该方案对临床治疗决策的启示,同时分享大会中值得关注的前沿探索,为国内临床工作者传递国际前沿声音。
01
《肿瘤瞭望》:本次您公布了HIMALAYA研究7年总生存数据,同时基于肿瘤缓解指标分层分析OS。和此前随访结果相比,这份超长随访数据带来了哪些新的启示?
Lorenza Rimassa 教授
意大利Humanitas大学及Humanitas研究医院
HIMALAYA是一项Ⅲ期研究,头对头对比STRIDE方案,也就是单次启动剂量曲美木单抗联合度伐利尤单抗,与索拉非尼,用于晚期/不可切除HCC患者一线治疗的疗效。研究的主要终点为STRIDE方案对比索拉非尼的总生存期。研究同时设置了度伐利尤单抗单药组,旨在验证该方案相较于索拉非尼的非劣效性。这项试验达到主要终点,STRIDE方案较索拉非尼实现了更长的总生存,目前STRIDE方案已经成为晚期HCC患者一线标准治疗方案之一。
我们此前已经公布过该研究的总生存期分析数据,在ESMO 2026大会上,我们进一步公布了HIMALAYA研究7年总生存期分析结果。这是目前晚期/不可切除HCC研究中可获得的最长随访数据。我们观察到,STRIDE组入组患者中有14%在7年时仍然存活;如果把获得客观缓解以及疾病稳定、也就是实现疾病控制的患者合并分析,7年生存率可达20%。
这样的结果在HCC领域是前所未有的。回顾既往数据,晚期HCC患者的历史5年生存率仅为5%,而我们现在看到14%的患者可以存活至7年。所以正如我所说,这一结果意义重大,提示即便是晚期HCC患者,也有机会实现长期生存。
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Oncology Frontier: You presented the 7-year overall survival (OS) data from the HIMALAYA trial, together with an analysis of OS stratified by tumor response. Compared with the results reported at earlier follow-up time points, what new insights do these long-term data offer?
Professor Rimassa: HIMALAYA is a phase III trial that compared the STRIDE regimen—one single priming dose of tremelimumab followed by durvalumab—with sorafenib with as first-line treatment for patients with advanced / unresectable HCC. The primary endpoint was overall survival for STRIDE versus sorafenib. The trial also included a durvalumab monotherapy arm that was tested for non-inferiority versus sorafenib. The trial met its primary endpoint, STRIDE achieved a longer overall survival compared to sorafenib, and STRIDE is now one of the first-line standard treatment options for patients with advanced HCC.
We had previously reported OS analyses from this study. At ESMO 2026, we presented the results of the 7-year OS analysis. These represent the longest follow-up data available from a trial for advanced / unresectable HCC. We observed that 14% of patients in the STRIDE arm were still alive at 7 years. When patients who achieved an objective response and those whose disease remained stable—that is, patients who achieved disease control—were analyzed together, the 7-year survival rate was 20%.
These findings are unprecedented in HCC. Historically, the 5-year survival rate among patients with advanced HCC was only 5%. We are now seeing that 14% of patients can survive for 7 years. This is a highly meaningful result, suggesting that long-term survival is possible even for patients with advanced HCC.
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《肿瘤瞭望》:在这项分析中,您将不同肿瘤缓解指标与长期OS进行关联。根据本次研究结果,在临床实践中,哪些肿瘤缓解指标更有助于医生预判接受STRIDE方案患者能否获得持久的长期生存?
Lorenza Rimassa 教授
意大利Humanitas大学及Humanitas研究医院
在这项7年总生存期分析中,我们证实整体有14%的患者在7年时仍然存活。随后我们按照肿瘤缓解、疾病控制、疾病稳定不同状态,评估了各组患者7年生存的概率。研究发现,实现疾病控制的患者7年生存概率最高,这一人群既包含获得客观缓解的患者,也包含疾病稳定的患者。具体来看,实现疾病控制的患者中有20%在7年时仍然存活,也就是刚才提到的客观缓解联合疾病稳定的人群。因此,疾病控制是提示患者7年生存概率更高的指标,而整个STRIDE队列的7年生存率为14%。
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Oncology Frontier: In this analysis, you examined the relationship between different tumor response measures and long-term OS. Based on the findings, which measures of tumor response are most useful in clinical practice for predicting whether patients receiving the STRIDE regimen are likely to achieve durable long-term survival?
Professor Rimassa: In this 7-year OS analysis, we confirmed that 14% of patients overall were still alive at 7 years. We then assessed the probability of 7-year survival according to tumor response and disease status, including disease control and stable disease. The analysis showed that patients who achieved disease control had the highest probability of surviving to 7 years. This group included both patients who achieved an objective response and those whose disease remained stable. Specifically, 20% of patients who achieved disease control were still alive at 7 years, as I mentioned earlier. Therefore, disease control is an indicator associated with a higher probability of 7-year survival, compared with the 14% 7-year survival rate in the overall STRIDE cohort.
03
《肿瘤瞭望》:这份7年生存数据,是不可切除HCC一线免疫治疗III期研究中随访时间最长的数据之一。该结果对于一线不可切除HCC的患者筛选与临床治疗决策,有怎样的指导意义?
Lorenza Rimassa 教授
意大利Humanitas大学及Humanitas研究医院
晚期HCC患者的一线治疗存在多种可选方案。借助STRIDE方案以及这项7年总生存期分析,我们证实部分患者能够实现疾病控制、获得长期生存,取得了前所未有的结果,有患者在治疗后7年仍然存活。同时研究也提示该方案安全性良好,在初步分析以及5年总生存期分析之后,我们并未发现新增的严重不良事件。另外,研究证实,无论患者基线ALBI分级为1级还是2、3级,STRIDE方案带来的生存获益均可保持,本研究入组患者的基线肝功能均为Child-Pugh A级。
因此我认为,对于以疾病控制、延长生存为治疗目标的患者,就目前已有的数据来看,STRIDE方案是优选方案。它是目前唯一拥有如此长期随访数据、可证实部分患者能够存活至7年的治疗方案。这也意味着,即便是晚期HCC患者,我们也可以将延长生存期、实现长期生存作为治疗目标。
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Oncology Frontier: These 7-year survival data represent one of the longest follow-up periods reported in a phase III trial of first-line immunotherapy for unresectable HCC. What implications do the findings have for patient selection and clinical treatment decisions in this setting?
Professor Rimassa: Several first-line treatment options are available for patients with advanced HCC. The STRIDE regimen and this 7-year OS analysis demonstrate that some patients can achieve disease control and long-term survival—an unprecedented result, with some patients still alive 7 years after treatment initiation. The study also indicates that the regimen has a favorable safety profile. Following the initial analysis and the 5-year OS analysis, we did not identify any new serious adverse events.
In addition, the study showed that the survival benefit with STRIDE was maintained regardless of whether patients had a baseline ALBI grade of 1 or grade 2 or 3. All patients enrolled in the study had Child-Pugh A liver function at baseline.
Therefore, in my view, for patients whose treatment goals are disease control and prolonged survival, STRIDE is a preferred option based on the data currently available. It is the only treatment regimen with such long-term follow-up demonstrating that some patients can remain alive for as long as 7 years. This also means that, even in advanced HCC, prolonging survival and achieving long-term survival can be realistic treatment goals.
04
《肿瘤瞭望》:在本次大会上,哪一项报告给您留下的印象最深?您觉得它的亮点体现在哪里?
Lorenza Rimassa 教授
意大利Humanitas大学及Humanitas研究医院
一项针对经治HCC患者的新型双特异性抗体Ⅰ/Ⅱ期研究结果让我印象很深。这项研究主要在亚洲开展,采用靶向GPC3和4-1BB的双特异性抗体BGB-B2033。研究在多线治疗后的晚期HCC人群中取得了36%的客观缓解率(ORR),同时安全性表现良好。基于这些数据,后续即将在全球范围内启动一项针对经治HCC患者的Ⅲ期研究。
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Oncology Frontier: Which presentation at this year's congress made the strongest impression on you, and what were its key highlights?
Professor Rimassa: I was particularly impressed by the results of a phase I/II study of a novel bispecific antibody in patients with previously treated HCC. The study was conducted primarily in Asia and evaluated BGB-B2033, a bispecific antibody targeting GPC3 and 4-1BB. Among patients with advanced HCC who had received multiple prior lines of therapy, the study reported an objective response rate (ORR) of 36%, with a favorable safety profile. Based on these data, a global phase III study in previously treated patients with HCC is planned to start soon.
Lorenza Rimassa 教授
意大利Humanitas大学及Humanitas研究医院
胃肠道肿瘤内科医生,肿瘤内科副教授,同时担任意大利米兰Humanitas大学、Humanitas癌症中心肝胆胰肿瘤科主任。
(来源:《肿瘤瞭望》编辑部)
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