Announcement • Jun 03
AstraZeneca Reports Positive Results From EMERALD-3 Phase III Trial For IMFINZI And IMJUDO Combined With Lenvatinib And TACE In Unresectable Hepatocellular Carcinoma
AstraZeneca reported positive results from the EMERALD-3 Phase III trial showing IMFINZI (durvalumab) in combination with IMJUDO (tremelimumab-actl), lenvatinib and transarterial chemoembolization (TACE), demonstrated a statistically significant and clinically meaningful improvement in progression-free survival (PFS) versus TACE alone for patients with unresectable hepatocellular carcinoma (HCC) eligible for embolization. Patients in the investigational arms were treated with the STRIDE regimen (Single Tremelimumab-actl Regular Interval Durvalumab), with or without lenvatinib, prior to TACE and then in combination with TACE thereafter. In a planned interim analysis, the STRIDE regimen combined with lenvatinib and TACE demonstrated a 30% reduction in the risk of disease progression or death versus TACE alone (based on a PFS hazard ratio [HR] of 0.70; 95% confidence interval [CI] 0.57-0.86; p=0.0007). The median PFS was 13.0 months for this regimen versus 9.8 months for TACE. The PFS improvement was broadly consistent across key prespecified patient subgroups. For the secondary endpoint of overall survival (OS), a positive trend was observed in favor of the STRIDE regimen with lenvatinib and TACE versus TACE alone (HR 0.84; 95% CI 0.65-1.09; p=0.1814). The key secondary endpoints of PFS and OS for the treatment arm evaluating the STRIDE regimen plus TACE versus TACE alone showed a clinically meaningful improvement in PFS (HR 0.71; 95% CI 0.56-0.91; nominal p=0.0062) and OS (HR 0.70; 95% CI 0.51-0.95; nominal p=0.0233) versus TACE alone. Median PFS was 12.9 months for STRIDE plus TACE versus 8.1 months for TACE alone. In a pre-planned exploratory analysis comparing the two investigational arms, a PFS improvement was observed favoring the lenvatinib-containing arm in patients with non-viral etiology (HR 0.70; 95% CI 0.44-1.09). The trial will continue to assess OS and other key secondary endpoints in both investigational arms. The safety profile for each combination was consistent with the known profiles of each medicine. Grade 3 or higher adverse events from all causes occurred in 71.4% of the patients in the STRIDE plus lenvatinib and TACE arm, and 64% of the patients in the STRIDE plus TACE arm, versus 28.6% in the TACE-only arm. Summary of PFS and OS results: Descriptive per the pre-specified multiplicity/hierarchy; no formal statistical inference is claimed. Stratified log rank. Nominal. Estimated using a stratified Cox proportional hazards model. Calculated using the Kaplan-Meier technique; CI derived based on Brookmeyer-Crowley method. There are no contraindications for IMFINZI (durvalumab) or IMJUDO (tremelimumab-actl). Severe and Fatal Immune-Mediated Adverse Reactions Important immune-mediated adverse reactions listed under Warnings and Precautions may not include all possible severe and fatal immune-mediated reactions. Immune-mediated adverse reactions, which may be severe or fatal, can occur in any organ system or tissue. Immune-mediated adverse reactions can occur at any time after starting treatment or after discontinuation. Monitor patients closely for symptoms and signs that may be clinical manifestations of underlying immune-mediated adverse reactions. Evaluate clinical chemistries including liver enzymes, creatinine, adrenocorticotropic hormone (ACTH) level, and thyroid function at baseline and before each dose. In cases of suspected immune-mediated adverse reactions, initiate appropriate workup to exclude alternative etiologies, including infection. Institute medical management promptly, including specialty consultation as appropriate. Withhold or permanently discontinue IMFINZI and IMJUDO depending on severity. In general, if IMFINZI and IMJUDO requires interruption or discontinuation, administer systemic corticosteroid therapy (1 mg to 2 mg/kg/day prednisone or equivalent) until improvement to Grade 1 or less. Upon improvement to Grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Consider administration of other systemic immunosuppressants in patients whose immune-mediated adverse reactions are not controlled with corticosteroid therapy. IMFINZI and IMJUDO can cause immune-mediated pneumonitis, which may be fatal. The incidence of pneumonitis is higher in patients who have received prior thoracic radiation. IMFINZI as a Single Agent In patients who did not receive recent prior radiation, the incidence of immune-mediated pneumonitis was 2.4% (34/1414), including fatal. In patients who received recent prior radiation, the incidence of pneumonitis (including radiation pneumonitis) in patients with unresectable Stage III NSCLC following definitive chemoradiation within 42 days prior to initiation of IMFINZI in PACIFIC was 18.3% (87/475) in patients receiving IMFINZI and 12.8% (30/234) in patients receiving placebo. Of the patients who received IMFINZI (475), 1.1% were fatal and 2.7% were Grade 3 adverse reactions. The incidence of pneumonitis (including radiation pneumonitis) in patients with LS-SCLC following chemoradiation within 42 days prior to initiation of IMFINZI in ADRIATIC was 14% (37/262) in patients receiving IMFINZI and 6% (16/265) in patients receiving placebo. Of the patients who received IMFINZI (262), 0.4% had a fatal adverse reaction and 2.7% had Grade 3 adverse reactions. The frequency and severity of immune-mediated pneumonitis in patients who did not receive definitive chemoradiation prior to IMFINZI were similar in patients who received IMFINZI as a single agent or with ES-SCLC or BTC when given in combination with chemotherapy. IMFINZI with IMJUDO Immune-mediated pneumonitis occurred in 1.3% (5/388) of patients receiving IMFINZI and IMJUDO, including fatal (0.3%) and Grade 3 (0.2%) adverse reactions. IMFINZI with IMJUDO and Platinum-Based Chemotherapy Immune-mediated pneumonitis occurred in 3.5% (21/596) of patients receiving IMFINZI in combination with IMJUDO and platinum-based chemotherapy, including fatal (0.5%), and Grade 3 (1%) adverse reactions. IMFINZI with IMJUDO and platinum-based chemotherapy can cause immune-mediated colitis, which may be fatal. IMFINZI and IMJUDO can cause immune-mediated colitis that is frequently associated with diarrhea. Cytomegalovirus (CMV) infection/reactivation has been reported in patients with corticosteroid-refractory immune-mediated colitis. In cases of corticosteroid-refractory colitis, consider repeating infectious workup to exclude alternative etiologies. IMFINZI as a Single Agent Immune-mediated colitis occurred in 2% (37/1889) of patients receiving IMFINZI, including Grade 4. IMFINZI and IMJUDO can cause primary or secondary adrenal insufficiency. For Grade 2 or higher adrenal insufficiency, initiate symptomatic treatment, including hormone replacement as clinically indicated.