Results from the phase III EMERALD-3 study found that combining the standard treatment of transarterial chemoembolization (TACE) with the immunotherapy-based STRIDE (single tremelimumab, regular interval durvalumab) regimen, with or without the targeted therapy lenvatinib, can slow the cancer’s growth and lengthen survival in patients with embolization-eligible hepatocellular carcinoma that cannot be removed with surgery. The research was presented at the 2026 ASCO Annual Meeting (Abstract LBA4000).
About EMERALD-3
“In the embolization-eligible setting for hepatocellular carcinoma, TACE has been the most practiced global standard of care for over 2 decades. However, outcomes remain poor, with a median progression-free survival of 8 to 10 months. Repeated TACE procedures wane in effect over time and risk further decline in liver function. Currently, there are no systemic therapy-based options approved for these patients globally,” said lead study author Ghassan K. Abou-Alfa, MD, PhD, MBA, JD, FASCO, of Memorial Sloan Kettering Cancer Center.
The global EMERALD-3 trial tested whether combining STRIDE with TACE, either with or without adding the oral targeted therapy drug lenvatinib, could delay cancer growth for people with embolization-eligible unresectable hepatocellular carcinoma that could not be removed with surgery, when compared to TACE alone. The study included 760 participants, all of whom were at least 18 years old, or over 21 for those living in Egypt or Singapore. Participants were predominantly male (83.2%) and Asian (72.1%).
Participants were randomly assigned to receive either STRIDE and lenvatinib with TACE (n = 293), STRIDE with TACE (n = 175), or TACE alone (n = 292).
Key Findings
In the STRIDE, lenvatinib, and TACE group, the median progression-free survival was 13 months vs 9.8 months in the TACE-alone group.
The STRIDE, lenvatinib, and TACE group had a median overall survival of 39.5 months vs 34.7 months in the TACE-alone group.
The 2-year overall survival rate in the triple-combination group was 66.9% vs 61.5% in the TACE-alone group.
When looking at the 175 participants who received STRIDE and TACE without lenvatinib compared to the first 175 participants who received TACE alone, those who received STRIDE and TACE still had a longer progression-free survival (12.9 months vs 8.1 months, respectively). The 2-year overall survival rate was also higher in this group (68% vs 57.8%, respectively).
Those who received STRIDE and TACE with or without lenvatinib experienced more side effects than those who received TACE alone. The rate of grade 3 or 4 adverse events was 62.7% in those who received STRIDE with lenvatinib and TACE, 48.6% for those who received STRIDE with TACE, and 18.6% for those who received TACE alone. The most common side effects in each group were consistent with the known side effects for each treatment.
The EMERALD-3 study is ongoing, and patients are being followed for overall survival final analyses.
DISCLOSURE: The EMERALD-3 study was funded by AstraZeneca. For full disclosures of the study authors, visit coi.asco.org.
