ASCO 2026: Triple therapy outperforms standard treatment in EMERALD-3 hepatocellular carcinoma trial

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Original story from the ASCO Annual Meeting

Results from the Phase 3 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 may help patients with embolization-eligible hepatocellular carcinoma that cannot be removed with surgery live longer. The research will be presented at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting, taking place May 29 to June 2 in Chicago.

Study at a glance

Focus: Embolization-eligible unresectable hepatocellular carcinoma (eeHCC)

Population: 760 participants

Main Takeaway: Combining single tremelimumab regular interval durvalumab (STRIDE) with transarterial chemoembolization (TACE), with or without lenvatinib, can slow cancer growth for people with embolization-eligible unresectable hepatocellular carcinoma that cannot be removed with surgery, and it may help them live longer.

Significance:

  • In 2026, the American Cancer Society (ACS) estimates that 42,340 people in the United States (U.S.) will be diagnosed with liver cancer, and 30,980 people will die from the disease. Over the past 4 decades, liver cancer diagnoses in the U.S. have tripled.
  • The most common type of liver cancer is called hepatocellular carcinoma (HCC), which accounts for more than 8 in 10 liver cancer diagnoses. HCC is commonly diagnosed at later stages, when surgery is not an option.
  • At later stages of disease, about 30% of patients are eligible for treatment with TACE. For more than 2 decades, this has been the standard of care for people with eeHCC that cannot be removed with surgery. However, cancer often grows or spreads in patients within 8 to 10 months of receiving this treatment.

ASCO Perspective Quote

“The significant improvement in progression-free survival observed in the phase III EMERALD-3 study positions this combinatorial regimen of single tremelimumab regular interval durvalumab (STRIDE) plus transarterial chemoembolization (TACE), with or without lenvatinib, as a compelling therapeutic option for patients with unresectable embolization-eligible hepatocellular carcinoma. These findings are likely to influence clinical practice and may be considered practice-changing for medical oncologists treating hepatocellular carcinoma globally,” said ASCO Expert Vishwanath Sathyanarayanan, MD, DM, Lead Oncosciences, Karnataka Region, Apollo Hospitals, Bangalore, India.

About the study 

“In the embolization-eligible setting for hepatocellular carcinoma, transarterial chemoembolization 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.

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 (293 participants), STRIDE with TACE (175 participants), or TACE alone (292 participants).

Key findings

  • In the STRIDE, Lenvatinib, and TACE group, the median progression-free survival (PFS) was 13 months vs. 9.8 months in the TACE-alone group.
  • The STRIDE, lenvatinib, and TACE group had a median overall survival (OS) of 39.5 months vs. 34.7 months in the TACE-alone group.
  • The 2-year OS 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 PFS (12.9 months vs. 8.1 months, respectively). The 2-year OS 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, which represent severe or life-threatening side effects, 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.

Next steps

The EMERALD-3 study is ongoing, and patients are being followed for OS final analyses.

The EMERALD-3 study was funded by AstraZeneca.

 

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