ASCO 2026 | EMERALD-3: efficacy and safety of STRIDE, lenvatinib, and TACE in eeHCC

It was a great delight. GI oncology has been really very big this year at ASCO, and I really was greatly honored on behalf of all of my co-authors to present on the EMERALD-3 study. As we all know, chemoembolization or transarterial chemoembolization, or what we call TACE, is a standard care therapy for intermediate-stage disease. The question is, can we really make it better? Can we enhance the survival or progression-free survival, which sadly at the moment is only about eight to 10 months? And yes, we can. If anything, we have been attempting to do this because as we all know, whenever you do the chemoembolization, you enhance certain cancer antigens, which of course will induce some of the immune checkpoints. And this is a great opportunity to add on the checkpoint inhibitors to really enhance the activity. And for that reason, for the study, we added on durvalumab as anti-PD-L1. We added to this also an enhancer of this activity, being anti-VEGF, being lenvatinib. And also, on top of the chain of command, we looked at anti-CTLA-4 with the tremelimumab. So as such, the study was combined of a triplet, the tremelimumab plus durvalumab plus TACE and the lenvatinib, and also an arm B, which was the tremelimumab plus durvalumab plus the TACE, and the third one was TACE only. We did compare arm A, which is the triplet, which is tremelimumab plus lenvatinib plus TACE, we call it together triplet, plus TACE, we compared to TACE alone. And then we did also look at PFS as primary point. Why PFS? It’s a locally advanced disease, prolonged survival. At the same time, we really care about what’s happening locally, and we compare that, and then ultimately, we carried on to look at OS, and then we did the same thing for arm B, triplet TACE compared to TACE, PFS and OS. What did we find out? Interestingly, we found out that the outcome was positive no matter how you look at it. It was statistically significant for an improvement in regard to the progression of your survival. 13 months for the triplet TACE compared to about nine months for the TACE. It was also the same thing, a trend of positivity in regard to the triplet plus TACE about 13 months compared to 9 as well. In regard to survival, by all means, it was also a trend of positive outcome. 39 months compared to 34 for triplet plus TACE. But impressively, when it came to arm B versus C, we saw a non-calculable yet, not even achievable yet, median survival for the triplet plus TACE compared to about 34 months for the TACE itself. So where do you go for this? So no doubt about it, these drugs are adding on to the value of the TACE. And by all means, because they’re all available, could we consider that we’re going to use those interventions, adding them onto TACE? By all means, we will. And this is what we’re going to apply as early as tomorrow morning. A nice question that was asked, and you recall, it was like about, what about comparing arm A to B? Because in other words, how much lenvatinib is adding on? And yes, I do agree with all the comments that were given. Really, the lenvatinib did not add much. Maybe a small exception of the patients from Japan who were non-viral. There was some add-on value for the lenvatinib. But for the general population, anywhere in the world, triplet TACE appeared to be the right therapy.

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