Imfinzi-Imjudo dual immunotherapy offers new option for 1st-line treatment of liver cancer < Pharma < Article

As AstraZeneca launches Imjudo (tremelimumab) without health insurance coverage in May, Korean liver cancer patients will likely have another immunotherapy option for first-line systemic treatment.

The dual immunotherapy of Imfinzi (durvalumab) and Imjudo (tremelimumab) is expected to provide a new alternative for patients who are ineligible for the current standard of care of Tecentriq (atezolizumab) and Avastin (bevacizumab) due to the high risk of bleeding.

In May, AstraZeneca will launch Imjudo, the company’s first-in-class anti-CTLA-4 immuno-oncology drug, without reimbursement in Korea.

The launch comes about 10 months after the U.K. company received approval from the Ministry of Food and Drug Safety (MFDS) on June 23, 2023, for administering Imjudo in combination with Imfinzi for the first-line treatment of adult patients with advanced or unresectable hepatocellular carcinoma.

In the first-line treatment of liver cancer, aside from the Tecentriq-Avastin combination that became the standard of care previously, combinations based on anti-PD-(L)1 immuno-oncology are now recommended as a priority after the Imfinzi-Imjudo combination demonstrated improved overall survival (OS) compared to sorafenib. 

In May 2022, the Tecentriq-Avastin combination also won reimbursement approval for the first-line treatment of liver cancer in Korea, making it a prioritized therapy. Still, there was an unmet need for some patients with a high risk of bleeding, requiring pre-operative measures such as ligation or the use of TKI monotherapy, including sorafenib or Lenvima (lenvatinib).

However, as the Imfinzi-Imjudo combination became available, Korean patients now have another immunotherapy alternative. The Imfinzi-Imjudo combination is recognized as a treatment that can be used without the bleeding concerns of Avastin, an anti-VEGF antibody, or the hepatotoxicity of TKIs.

Furthermore, the Imfinzi-Imjudo combination is licensed as a STRIDE (Single Tremelimumab Regular Interval Durvalumab) dosing regimen. This regimen consists of a single 1,500 mg dose of Imfinzi followed by 300 mg of Imjudo every four weeks, providing greater dosing convenience compared to the Tecentriq-Avastin combination, which requires both drugs to be administered every three weeks.

Besides, bevacizumab, combined with Tecentriq combination, is still an expensive treatment, although its price has dropped significantly since the recent introduction of biosimilars.

Even though reimbursement for immuno-oncology drugs is currently limited to a maximum of two years, the cost of bevacizumab significantly impacts health insurance finances.

Therefore, some experts think that the Imfinzi-Imjudo combination therapy, which can be administered only once and maintenance treatment with Imfinzi alone, may have an advantage in reimbursement review.

For this reason, liver cancer experts in Korea predict it will be relatively easy to apply for insurance benefits for Impinzi-Imjudo combination therapy.

“Leading international guidelines already prioritize immuno-oncology-based therapies for the first-line treatment of liver cancer,” said Professor Yu Su-jong of the Department of Gastroenterology at Seoul National University Hospital and an academic board member of the Korean Liver Cancer Association. “In particular, the Imfinzi-Imjudo combination is an essential treatment for patients who cannot use the Tecentriq-Avastin combination due to the high risk of bleeding. So, it should be reimbursed in Korea.”