YU-YUN SHAOChen, Ching-TsoChing-TsoChenCHIEN-HUAI CHUANGTUNG-HUNG SUMING-CHIH HOTAI-CHUNG TSENGTSUNG-HAO LIUWu, Tsung-CheTsung-CheWuANN-LII CHENGCHIH-HUNG HSU2025-05-142025-05-142025-05-18https://scholars.lib.ntu.edu.tw/handle/123456789/729273Background: Chronic hepatitis B virus (HBV) infection is an etiology of HCC, but clinical trials using immune checkpoint inhibitors (ICIs) usually exclude patients with chronic active hepatitis B (serum HBV viral load > 2000 IU/mL). This study examined the safety and efficacy of concurrently administering the ICI and anti-HBV medications in this patient population. Methods: In this single-arm phase 2 clinical trial, we enrolled patients with advanced HCC and untreated chronic active hepatitis B. Patients received 1500 mg of durvalumab every 4 weeks alone or in combination with 300 mg of tremelimumab on day 1 (the STRIDE regimen). Anti-HBV treatment with entecavir was simultaneously initiated. The primary endpoint was the rate of HBV reactivation. Results: We enrolled 30 patients, whose mean baseline HBV viral load was 770,986 IU/mL. No patients experienced HBV reactivation or HBV-associated hepatitis. Hepatitis flare was noted in 8 (26.7%) patients, but none of them were associated with HBV reactivation. The objective tumor response rate was 10% and 25% for the durvalumab treatment alone and the STRIDE regimen, respectively. Conclusion: For patients with chronic active hepatitis B, ICI therapy could be promptly initiated as long as anti-HBV medications were administered simultaneously. Clinical Trial Registration: NCT04294498 © The Author(s), under exclusive licence to Springer Nature Limited 2025.en[SDGs]SDG3journal article10.1038/s41416-025-02978-740128285