STRIDE Shows Feasibility in High-Risk HCC Patients Excluded From Pivotal Trials: Journal of Hepatology | October 2026

What Did the Study Find?

SIERRA prospectively evaluated first-line STRIDE—one dose of tremelimumab 300 mg plus durvalumab 1,500 mg, followed by durvalumab every four weeks—in 111 patients with unresectable HCC and poor-prognosis features. Participants had Child–Pugh B7/B8 disease (n=44), Child–Pugh A with ECOG performance status 2 (n=47), or chronic main-trunk portal-vein thrombosis/Vp4 (n=20).

Grade 3–4 adverse events considered possibly treatment-related within six months occurred in 19.8% overall: 18.2%, 19.1% and 25.0% across the three cohorts, respectively. Investigator-assessed objective response was 14.4% overall, but varied substantially—6.8% in Child–Pugh B7/B8, 21.3% with ECOG 2 and 15.0% with Vp4. There was no sorafenib, lenvatinib or immunotherapy comparator. pubmed.ncbi.nlm.nih.gov

Why Does It Matter?

Up to two-thirds of real-world advanced-HCC patients may have characteristics underrepresented in phase 3 trials. SIERRA provides valuable prospective safety data, but the modest Child–Pugh B response and single-arm design mean that preserved-liver-function trial results cannot simply be extrapolated to every decompensated patient.

GastroAGI Takeaway

STRIDE is feasible in selected poor-prognosis HCC, but Child–Pugh B treatment requires individualized assessment and should not be regarded as fully validated by SIERRA alone.