Ziihera® (zanidatamab-hrii) Combinations Demonstrate Sustained Survival at Three Years in First-Line HER2+ Advanced Gastroesophageal Adenocarcinoma at ESMO 2026
The chemotherapy-only Ziihera combination now shows a statistically significant survival benefit over trastuzumab plus chemotherapy.
Sentiment and the balance of points
Rhea-AI Sentiment reads the wording of the document, how positive or negative its language is on a 1 to 5 scale. The balance of points shown with the takes weighs what the document actually discloses, so the two can disagree, for example when a trial that missed its main goal is described in upbeat language.
Rhea-AI Summary
Jazz Pharmaceuticals (JAZZ) reported updated Phase 3 survival results for Ziihera combinations in first-line HER2-positive advanced gastroesophageal adenocarcinoma at ESMO 2026. At 35.3 months of median follow-up, Ziihera plus tislelizumab and chemotherapy delivered median overall survival of 27.0 months, versus 19.6 months with trastuzumab plus chemotherapy, reducing the risk of death by 35%. Estimated three-year survival was 39.8% versus 22.9%.
Ziihera plus chemotherapy achieved median survival of 22.9 months and a statistically significant 24% reduction in death risk versus trastuzumab plus chemotherapy. Adding tislelizumab to Ziihera and chemotherapy did not produce a statistically significant survival difference. Safety profiles remained consistent with the first interim analysis. Both Ziihera regimens received FDA approval for specified first-line patient groups on August 25, 2026.
How this balance works
Rhea-AI gives every point it takes from this document a weight. Minor counts 1, Moderate 3 and Major 9, so one Major point outweighs several Minor ones. The bar adds up the weights on each side, and when neither side holds more than 65% of the total the balance reads Mixed.
It reads the document as published, with the same rules for every company, and it does not look at what the market expected or at how the stock traded, so a point can be objectively good on a day the stock falls.
Rhea-AI Sentiment measures something else, the tone of the wording.
Positive
- Major pointZiihera plus tislelizumab and chemotherapy achieved 27.0-month median survival versus 19.6 months with trastuzumab plus chemotherapy; death risk fell 35%.
- Major pointZiihera plus chemotherapy achieved 22.9-month median survival versus 19.6 months with trastuzumab plus chemotherapy; death risk fell 24% (P=0.0088).
- Major pointFDA approval on August 25, 2026 covered both Ziihera combinations for specified first-line HER2-positive advanced gastroesophageal cancer groups.
- Moderate pointNCCN preferred-therapy inclusion covers both regimens; the tislelizumab combination is preferred irrespective of PD-L1 status.
- Minor pointEstimated 36-month survival was 39.8% with the tislelizumab combination, 31.5% with Ziihera plus chemotherapy, versus 22.9% with control.
2 minor points
- Minor pointMean treatment duration was 64.1 weeks with the tislelizumab combination, 52.6 with Ziihera plus chemotherapy, versus 42.3 with control.
- Minor pointSafety profiles of both Ziihera-containing regimens remained consistent with the first interim analysis.
Negative
- Moderate pointAdding tislelizumab to Ziihera plus chemotherapy did not significantly improve overall survival: HR 0.81, P=0.0502.
AI-generated analysis. How Rhea-AI works. Not financial advice.
Nearly
Mature HERIZON-GEA-01 results show Ziihera plus chemotherapy delivered statistically significant and clinically meaningful OS benefit, reducing the risk of death by
For
"For patients with HER2+ advanced GEA, long-term survival remains difficult to achieve. With longer follow-up, Ziihera-containing regimens demonstrated a durable overall survival benefit, with nearly
At the data cutoff, median follow-up was 35.3 months, 9.4 months longer than at the first interim analysis. Key findings included:
- Ziihera plus tislelizumab and chemotherapy sustained its OS benefit versus trastuzumab plus chemotherapy, with an improved HR: Median OS reached 27.0 months (
95% confidence interval [CI]: 23.7-32.2), the longest reported in a Phase 3 trial in this setting, compared with 19.6 months with trastuzumab plus chemotherapy. The Ziihera plus tislelizumab and chemotherapy regimen reduced the risk of death by35% (hazard ratio [HR] 0.65;95% CI: 0.52-0.80), improving from an HR of 0.72 at the first interim analysis. - Nearly
40% of patients receiving Ziihera plus tislelizumab and chemotherapy were alive at three years: Estimated 36-month OS was39.8% with Ziihera plus tislelizumab and chemotherapy,31.5% with Ziihera plus chemotherapy and22.9% with trastuzumab plus chemotherapy. - Ziihera plus chemotherapy demonstrated a statistically significant and clinically meaningful OS improvement versus trastuzumab plus chemotherapy: Median OS was 22.9 months (
95% CI: 19.9-27.6) with Ziihera plus chemotherapy compared with 19.6 months (95% CI: 16.9-22.2) with trastuzumab plus chemotherapy. Ziihera plus chemotherapy reduced the risk of death by24% (HR 0.76;95% CI: 0.62-0.93; P=0.0088). - Ziihera plus tislelizumab and chemotherapy showed a meaningful trend toward improved OS versus Ziihera plus chemotherapy: Median OS was approximately four months longer with Ziihera plus tislelizumab and chemotherapy than with Ziihera plus chemotherapy (27.0 versus 22.9 months; HR 0.81;
95% CI: 0.65-1.00; P=0.0502). The difference did not reach statistical significance. Mean duration of treatment was longest for Ziihera plus tislelizumab and chemotherapy (64.1 weeks): 11.5 weeks longer than Ziihera plus chemotherapy (52.6 weeks), and 21.8 weeks longer than trastuzumab plus chemotherapy (42.3 weeks). - Safety profiles remained unchanged with longer follow-up: The safety profiles of both Ziihera-containing regimens were consistent with the first interim analysis, supporting the tolerability of prolonged treatment.
"These HERIZON-GEA-01 three-year landmark results demonstrate meaningful survival outcomes for patients with HER2+ advanced GEA," said Rob Iannone, M.D., M.S.C.E., executive vice president, global head of R&D, and chief medical officer of Jazz Pharmaceuticals. "The statistically significant survival benefit observed with Ziihera plus chemotherapy and the durable outcomes seen with Ziihera plus tislelizumab and chemotherapy cement Ziihera as the new HER2-targeted backbone therapy in first-line HER2+ advanced GEA."
The Ziihera-containing regimens were recently included as preferred therapies in the National Comprehensive Cancer Network® (NCCN®) Clinical Practice Guidelines in Oncology® for Gastric Cancer, and Esophageal and Esophagogastric Junction Cancers, and Ziihera plus tislelizumab and chemotherapy is the only preferred HER2+ regimen irrespective of PD-L1 status.
These results follow the August 25, 2026,
The
Additional Important Safety Information related to Ziihera use in GEA is provided below. Please see full Prescription, including Boxed Warnings at https://pp.jazzpharma.com/pi/ziihera.en.USPI.pdf.
About the Phase 3 HERIZON-GEA-01 Trial
HERIZON-GEA-01 (NCT05152147) is a global, randomized, open-label Phase 3 trial, conducted jointly with BeOne Medicines, to evaluate and compare the efficacy and safety of zanidatamab plus chemotherapy, with and without tislelizumab, to trastuzumab plus chemotherapy as first-line treatment for adult patients with advanced/metastatic HER2+ GEA. The trial randomized 914 patients from approximately 225 trial sites in more than 30 countries. Appropriate patients for this trial had unresectable locally advanced, recurrent or metastatic HER2+ GEA (adenocarcinomas of the stomach or esophagus, including the gastroesophageal junction), defined as 3+ HER2 expression by IHC or 2+ HER2 expression by IHC with ISH positivity per central assessment. Patients were randomized to the three trial arms: zanidatamab in combination with chemotherapy and tislelizumab; zanidatamab in combination with chemotherapy; and trastuzumab plus chemotherapy. The trial evaluated dual primary endpoints, PFS per blinded independent central review (BICR) and OS.
About Gastroesophageal Adenocarcinoma
GEA, including cancers of the stomach, gastroesophageal junction, and esophagus, is the fifth most common cancer worldwide, and approximately
About Ziihera® (zanidatamab-hrii)
Ziihera (zanidatamab-hrii) is a bispecific HER2-directed antibody that binds to two extracellular sites on HER2. Binding of zanidatamab with HER2 results in internalization leading to a reduction in HER2 expression of the receptor on the tumor cell surface. Zanidatamab induces CDC, ADCC, and ADCP. These mechanisms result in tumor growth inhibition and cell death in vitro and in vivo.6
Gastroesophageal adenocarcinoma (GEA): In the United States, Ziihera is indicated for the first-line treatment of adults with HER2+ locally advanced or metastatic gastroesophageal adenocarcinoma (GEA), including cancers of the stomach, gastroesophageal junction and esophagus, in combination with tislelizumab-jsgr and fluoropyrimidine- and platinum-containing chemotherapy (HER2+ IHC 3+ and IHC 2+/ISH+ as detected by an FDA-authorized test); and in combination with fluoropyrimidine- and platinum-containing chemotherapy (HER2+ IHC 3+ as detected by an FDA-authorized test).
Biliary tract cancer (BTC): In
Zanidatamab is being developed in multiple clinical trials as a targeted treatment option for patients with solid tumors that express HER2. Zanidatamab is being developed by Jazz and BeOne Medicines under license agreements from Zymeworks, which first developed the molecule.
The FDA granted three Breakthrough Therapy designations for zanidatamab's development: one as a single agent for previously treated HER2 gene-amplified BTC, one in combination with fluoropyrimidine- and platinum-containing chemotherapy, with or without tislelizumab for first-line HER2+ unresectable locally advanced or metastatic gastric, gastroesophageal junction (GEJ), or esophageal GEA, and one for the treatment of adults with previously treated, locally advanced, unresectable, or metastatic HER2+ colorectal cancer (CRC). The FDA also granted two Fast Track designations for zanidatamab: one as a single agent for refractory BTC and one in combination with standard-of-care chemotherapy for first-line GEA. Additionally, zanidatamab has received Orphan Drug designations from the FDA for the treatment of BTC, gastric (including GEJ) cancer, and esophageal cancer, as well as Orphan Drug designations from the European Medicines Agency for the treatment of BTC, gastric/gastroesophageal junction cancer, and esophageal cancer. Jazz continues to pursue additional regulatory approvals for zanidatamab in markets worldwide.
Important Safety Information for ZIIHERA
|
WARNING: DIARRHEA and EMBRYO-FETAL TOXICITY
ZIIHERA, in combination with fluoropyrimidine- and platinum-containing chemotherapy, with or without
Embryo-Fetal Toxicity: Exposure to ZIIHERA during pregnancy can cause embryo-fetal harm. Advise patients |
Diarrhea: ZIIHERA can cause severe diarrhea.
When ZIIHERA is used in combination with fluoropyrimidine- and platinum-containing chemotherapy with or without tislelizumab-jsgr, severe, life threatening, and fatal cases of diarrhea can occur despite loperamide prophylaxis. The risk of severe and life threatening diarrhea is higher when ZIIHERA is administered with chemotherapy and tislelizumab-jsgr, with a higher risk in patients aged ≥ 65 years compared to younger patients. Advise patients to increase oral fluids, begin antidiarrheals, and notify their healthcare provider immediately if diarrhea occurs.
Administer antidiarrheal prophylaxis with loperamide in cycle 1 for all patients receiving ZIIHERA in combination with fluoropyrimidine- and platinum-containing chemotherapy with or without tislelizumab-jsgr. Begin loperamide at the first loose stool when ZIIHERA is administered in combination with chemotherapy. Administer fluids, electrolytes, and additional antidiarrheal agents as necessary. Before modifying the dose of ZIIHERA, evaluate, modify or discontinue drug(s) contributing to diarrhea in accordance with their respective prescribing information. Withhold, reduce the dose, or permanently discontinue ZIIHERA based on severity.
If treating patients with ZIIHERA in combination with FOLFOX, do not administer the fluorouracil bolus.
ZIIHERA in combination with chemotherapy and tislelizumab-jsgr
Diarrhea was reported in
In cycle 1, diarrhea at Grade 4 severity occurred in
ZIIHERA in combination with chemotherapy
Diarrhea was reported in
In cycle 1, diarrhea at Grade 4 severity occurred in
Embryo-Fetal Toxicity: Based on the mechanism of action, ZIIHERA can cause fetal harm when administered to a pregnant woman. There are no human or animal data on the use of ZIIHERA in pregnancy. In literature reports, use of a HER2-directed antibody during pregnancy resulted in cases of oligohydramnios and oligohydramnios sequence manifesting as pulmonary hypoplasia, skeletal abnormalities, and neonatal death.
Verify the pregnancy status of females of reproductive potential prior to the initiation of ZIIHERA. Advise pregnant women and females of reproductive potential that exposure to ZIIHERA during pregnancy or within 4 months prior to conception can result in fetal harm. Advise females of reproductive potential to use effective contraception while receiving ZIIHERA and for 4 months following the last dose of ZIIHERA.
Left Ventricular Dysfunction (LVD): ZIIHERA can cause decreases in left ventricular ejection fraction (LVEF).
Assess LVEF prior to initiation of ZIIHERA and at regular intervals during treatment. Withhold dose or permanently discontinue ZIIHERA based on severity of adverse reactions.
The safety of ZIIHERA has not been established in patients with a baseline ejection fraction that is <
ZIIHERA in combination with chemotherapy and tislelizumab-jsgr
LVEF decrease (an absolute decline in LVEF of >
ZIIHERA in combination with chemotherapy
LVEF decrease was observed in
Prior to each dose of ZIIHERA, administer premedication to prevent potential IRRs. Monitor patients for signs and symptoms of IRR during ZIIHERA administration and as clinically indicated after completion of infusion. Have medications and emergency equipment to treat IRRs available for immediate use.
If an IRR occurs, slow or stop the infusion, and administer appropriate medical management. Monitor patients until complete resolution of signs and symptoms before resuming. Permanently discontinue ZIIHERA in patients with recurrent severe or life-threatening IRRs.
ZIIHERA in combination with chemotherapy and tislelizumab-jsgr
An IRR was reported in
ZIIHERA in combination with chemotherapy
An IRR was reported in
Adverse Reactions
ZIIHERA in combination with chemotherapy and tislelizumab-jsgr
Serious adverse reactions occurred in
Permanent discontinuation of ZIIHERA occurred in
The most common adverse reactions (≥
ZIIHERA in combination with chemotherapy
Serious adverse reactions occurred in
Permanent discontinuation of ZIIHERA occurred in
The most common adverse reactions (≥
Pediatric Use: Safety and efficacy of ZIIHERA have not been established in pediatric patients.
Geriatric Use
ZIIHERA in combination with chemotherapy and tislelizumab-jsgr
Of 302 patients randomized to ZIIHERA in combination with chemotherapy and tislelizumab-jsgr in HERIZON-GEA-01, there were 139 (
There was a higher incidence of Grade ≥ 3 adverse reactions observed in patients aged ≥ 65 years (
There was an increased incidence of fatal adverse reactions in patients aged ≥ 65 years (
ZIIHERA in combination with chemotherapy
Of 304 patients randomized to ZIIHERA in combination with chemotherapy in HERIZON-GEA-01, there were 130 (
No overall differences in safety were observed between patients aged ≥ 65 years and younger adult patients.
® TEVIMBRA (tislelizumab) is a registered trademark of BeOne Medicines.
About Jazz Pharmaceuticals
Jazz Pharmaceuticals plc (Nasdaq: JAZZ) is a global biopharma company whose purpose is to innovate to transform the lives of patients and their families. We are dedicated to developing life-changing medicines for people with rare disease — often with limited or no therapeutic options. We have a diverse portfolio of medicines, including leading therapies addressing epilepsies, cancers and sleep disorders. Our patient-focused and science-driven approach powers pioneering research and development advancements across our robust pipeline of innovative therapeutics. Jazz is headquartered in Dublin, Ireland with research and development laboratories, manufacturing facilities and employees in multiple countries committed to serving patients worldwide. Please visit www.jazzpharmaceuticals.com for more information.
Cautionary Note Concerning Forward-Looking Statements
This press release contains forward-looking statements, including, but not limited to, statements related to the potential therapeutic and differentiated clinical benefits of Ziihera and of combination therapies with Ziihera, including Ziihera's potential to extend survival, Ziihera's potential as a new standard of care in HER2+ first-line GEA and other HER2-expressing cancers and other statements that are not historical facts. These forward-looking statements are based on Jazz Pharmaceuticals' current plans, objectives, estimates, expectations and intentions and inherently involve significant risks and uncertainties. Actual results and the timing of events could differ materially from those anticipated in such forward-looking statements as a result of these risks and uncertainties, which include, without limitation, risks and uncertainties associated with the successful completion of regulatory activities and uncertain regulatory approval, risks related to failure or delays in successfully initiating or completing clinical trials and assessing patients and other risks and uncertainties affecting Jazz Pharmaceuticals and its development programs, including those described from time to time under the caption "Risk Factors" and elsewhere in Jazz Pharmaceuticals' Securities and Exchange Commission filings and reports, including Jazz Pharmaceuticals' Annual Report on Form 10-K for the year ended December 31, 2025 and future filings and reports by Jazz Pharmaceuticals. Other risks and uncertainties of which Jazz Pharmaceuticals is not currently aware may also affect Jazz Pharmaceuticals' forward-looking statements and may cause actual results and the timing of events to differ materially from those anticipated. The forward-looking statements herein are made only as of the date hereof or as of the dates indicated in the forward-looking statements, even if they are subsequently made available by Jazz Pharmaceuticals on its website or otherwise. Jazz Pharmaceuticals undertakes no obligation to update or supplement any forward-looking statements to reflect actual results, new information, future events, changes in its expectations or other circumstances that exist after the date as of which the forward-looking statements were made.
Contacts:
Media:
CorporateAffairsMediaInfo@jazzpharma.com
Ireland +353 1 637 2141
U.S. +1 215 867 4948
Investor:
InvestorInfo@jazzpharma.com
Ireland +353 1 634 7800
U.S. +1 650 496 2717
1 Bray F., et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2024 April; doi.org/10.3322/caac.21834Digital Object Identifier (DOI).
2 Abrahao-Machado I.F., et al. HER2 testing in gastric cancer: An update WorldJGastroenterol. 2016;22(19):4619-4625.
3 Van Custem E., et al. HER2 screening data from ToGA: targeting HER2 in gastric and gastroesophageal junction cancer. Gastric Cancer. 2015;18(3):476-484.
4 Stroes, C.I., et al. A systematic review of HER2 blockade for the curative treatment of gastroesophageal adenocarcinoma: Successes achieved and opportunities ahead. CancerTreatRev. 2021;99:102249.
5 Tabernero J., et al. HERIZON-GEA-01: Zanidatamab + chemo ± tislelizumab for 1L treatment of HER2-positive gastroesophageal adenocarcinoma. Taylor & Francis. 2022 July; doi.org/10.2217/fon-2022-0595.
6 ZIIHERA (zanidatamab-hrii) Prescribing Information.

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SOURCE Jazz Pharmaceuticals plc
FAQ
AI-generated questions and answers. How Rhea-AI works. Not financial advice.
What survival results did Jazz report for Ziihera plus tislelizumab in HERIZON-GEA-01?
Ziihera plus tislelizumab and chemotherapy achieved 27.0 months median overall survival, compared with 19.6 months for trastuzumab plus chemotherapy. The risk of death was reduced by 35%, and estimated survival at 36 months was 39.8% versus 22.9%.
Did Ziihera plus chemotherapy significantly improve survival in HERIZON-GEA-01?
Yes. Ziihera plus chemotherapy achieved a statistically significant 24% reduction in the risk of death versus trastuzumab plus chemotherapy, with P=0.0088. Median overall survival was 22.9 months versus 19.6 months.
Which patients are covered by the FDA approvals for Ziihera combinations in gastroesophageal cancer?
The approvals cover adults with HER2-positive unresectable locally advanced or metastatic gastroesophageal adenocarcinoma, with different HER2 test requirements for each regimen. Ziihera plus tislelizumab and fluoropyrimidine- and platinum-containing chemotherapy covers IHC 3+ or IHC 2+/ISH+ disease; Ziihera plus that chemotherapy without tislelizumab covers IHC 3+ disease.
How was Jazz's HERIZON-GEA-01 trial designed?
HERIZON-GEA-01 was a global, randomized, open-label Phase 3 trial involving 914 patients at approximately 225 sites in more than 30 countries. Conducted jointly with BeOne Medicines, it compared two Ziihera-containing regimens against trastuzumab plus chemotherapy. Its dual primary endpoints were overall survival and progression-free survival assessed by blinded independent central review.