A new approach for treating liver cancer can delay the disease from progressing compared with standard methods, according to results from a phase 3 clinical trial presented at the nation’s premiere gathering of cancer doctors.
An estimated 42,000 new cases of liver cancer are diagnosed in the United States every year, according to the American Cancer Society, and rates have tripled over the past four decades. The most common type is hepatocellular carcinoma (HCC).
The new treatment involves adding two immunotherapy drugs to a procedure called TACE (transarterial chemoembolization) to slow the growth of intermediate-stage HCC. Using tiny beads to cut off the tumor blood supply, TACE delivers chemotherapy directly to the tumor.
The trial, called EMERALD-3, showed that compared with the standard protocol, adding dual immunotherapy to TACE significantly increased “progression-free survival” — the length of time during and after treatment that a patient lives without the cancer coming back or getting worse.
In addition, when a targeted therapy was also added to the therapy, the new treatment extended the median progression-free survival by 30%.
“Controlling liver cancer growth is essential because it directly impacts both survival and liver function,” explains Memorial Sloan Kettering Cancer Center (MSK) medical oncologist Ghassan K. Abou-Alfa, MD, JD, MBA, PhD (hc), who led the study. “By combining dual immunotherapy with TACE, we give patients a better chance of living longer while preserving a healthy, working liver,” Dr. Abou-Alfa says. “For our patients and their families, this translates into real, meaningful time together.”
Dr. Abou-Alfa presented the results at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting in May.
The need to improve on TACE
TACE has been the standard treatment for more than two decades, with few improvements along the way. It’s mainly used when a tumor can’t be surgically removed but hasn’t spread beyond the liver. In most people, TACE keeps the cancer in check for less than a year, and the median survival time following the treatment is slightly more than two years.
Dr. Abou-Alfa decided to investigate whether adding the immunotherapy drugs durvalumab (Imfinzi®) and tremelimumab (Imjudo®) to TACE would make it work better. The combination of these drugs, called STRIDE, was approved to treat advanced liver cancer in 2022, based on earlier trials led by Dr. Abou-Alfa.
Some patients in EMERALD-3 received an additional drug called lenvatinib (Lenvima®), which stops the growth of blood vessels that nourish tumors.
Clinical trial design and results
The EMERALD-3 trial included 760 patients at 171 institutions across 22 countries. Participants were randomly assigned to receive TACE alone, TACE plus STRIDE, or TACE plus STRIDE plus lenvatinib. There were several key findings:
Improved progression-free survival (PFS)
- Adding STRIDE + lenvatinib to TACE significantly delayed cancer progression compared with TACE alone (median PFS of 13 months vs. 9.8 months).
- Adding STRIDE alone to TACE also appeared to delay cancer progression, although results are preliminary.
A positive trend for overall survival
- STRIDE + TACE with or without lenvatinib resulted in patients living longer on average, but this result wasn’t yet statistically definitive.
Predictable side effects
- More serious side effects occurred in the combination groups (63% for STRIDE + lenvatinib + TACE vs. 19% for TACE alone), which was consistent with what’s already known about these drugs.
Following the science to improve treatment
Dr. Abou-Alfa says the research investigating TACE has evolved over the past decade. Previous studies by Dr. Abou-Alfa and his MSK colleagues suggested adding chemotherapy to embolization was unnecessary. In 2016, they published findings showing that using beads alone to block the tumor’s blood supply (called bland embolization) worked just as well without chemotherapy.
But more recent research at MSK found that the chemotherapy is in fact needed for the immunotherapy to work well: When chemotherapy attacks cancer cells, those dying cells release pieces of themselves. These fragments act like an alarm that wakes up the immune system and alerts it to attack the cancer.
“We’re proud that we continued researching this approach, even though our new findings contradicted our earlier discovery,” Dr. Abou-Alfa says. “Following the science led us to understand how to use immunotherapy more effectively for our patients.”
Many specialists for a complex disease
Dr. Abou-Alfa adds that the EMERALD-3 results show why it’s so important to have different types of cancer specialists working together to treat liver cancer. TACE is usually performed by interventional radiologists, who specialize in using minimally invasive procedures, guided by imaging, to treat tumors. Adding STRIDE means medical oncologists will also be involved to give the immunotherapy drugs.
Looking ahead, experts from different specialties will need to collaborate to design and conduct new trials. These studies will help determine the best drug combinations — such as adding different immunotherapies or targeted therapies as they become available. Dr. Abou-Alfa expects researchers will be very interested in adding STRIDE to another type of embolization called radioembolization, which delivers radiation rather than chemotherapy.
“Liver cancer is a very complex disease because you’re dealing with two problems at once — the cancer itself and the liver damage that often comes with it,” Dr. Abou-Alfa says. “To give patients the best possible care, specialists from different fields need to work closely together and have ongoing conversations about the right treatment approach for every patient.”
Key Takeaways
- The most common type of liver cancer is hepatocellular carcinoma (HCC).
- A procedure called TACE treats intermediate-stage HCC by cutting off the tumor blood supply and delivering chemotherapy directly to the tumor.
- An international phase 3 clinical trial, led at MSK by Dr. Ghassan K. Abou-Alfa, found that adding two immunotherapy drugs to TACE slows the growth of intermediate-stage HCC.
- The new approach preserves liver function and gives patients a better chance of living longer.
The study was funded by AstraZeneca.