EMERALD-3 Trial Shows Imfinzi-Based Combination Delays Liver Cancer Progression

Patients with unresectable hepatocellular carcinoma who were eligible for embolization lived longer without their cancer getting worse when treated with Imfinzi plus Imjudo, Lenvima (lenvatinib) and transarterial chemoembolization compared with embolization alone, according to results from the phase 3 EMERALD-3 trial conducted at 171 centers across 22 countries.

These findings are meaningful for patients because embolization alone, while considered standard treatment, often controls the cancer for only a limited time. Most patients who receive embolization by itself see their disease progress or return within six to ten months.

Hepatocellular carcinoma, or HCC, is the most common type of liver cancer. In 2026, more than 200,000 patients with HCC are expected to be eligible for embolization.

Embolization, also called transarterial chemoembolization or TACE, is a procedure designed to slow tumor growth. During the treatment, doctors guide a thin tube through a blood vessel into the liver. They then block the blood supply feeding the tumor. Chemotherapy can also be delivered directly into the tumor at the same time. By cutting off blood flow and delivering cancer medicine directly where it is needed, doctors aim to shrink or control the tumor.

EMERALD-3 combination improves progression-free survival in liver cancer

The EMERALD-3 trial met its primary goal. Patients who received Imfinzi, Imjudo, Lenvima and embolization experienced a statistically significant and clinically meaningful improvement in progression-free survival compared with those who received embolization alone.

Progression-free survival simply means the length of time patients live without their cancer getting worse. For many patients, delaying progression can mean more time before needing additional treatment.

At the time of an interim analysis, the combination also showed a trend toward improved overall survival, which refers to how long patients live after starting treatment. Overall survival is a key secondary goal of the study, and researchers will continue following patients to better understand the long-term results.

Patients in the investigational groups received what is known as the STRIDE regimen, short for Single Tremelimumab Regular Interval Durvalumab. This includes a one-time starting dose of Imjudo added to ongoing treatment with Imfinzi given every four weeks. Some patients also received Lenvima, a targeted therapy. These medicines were started before embolization and then continued alongside the procedure.

Although it was not formally tested at this time, the group that received the STRIDE regimen plus embolization without Lenvima also showed strong trends toward improved progression-free survival and overall survival compared with embolization alone.

Researchers noted that patients whose liver cancer can be treated with embolization currently have limited options beyond the procedure itself to help keep the disease from returning. These findings suggest that adding dual immunotherapy, with or without Lenvima, may help lower the risk of the cancer progressing.

How the EMERALD-3 liver cancer trial was conducted

EMERALD-3 is a randomized, open-label, sponsor-blinded, global phase 3 trial that enrolled 760 patients with unresectable HCC who were eligible for embolization.

Participants were assigned to receive either embolization plus Imfinzi, Imjudo and Lenvima, embolization plus Imfinzi and Imjudo, or embolization alone. The study initially enrolled 175 patients in each group. After that, enrollment continued between the Imfinzi, Imjudo and Lenvima group and the embolization-alone group until each of those groups included approximately 275 patients.

Patients in the investigational groups received a single 300 milligram dose of Imjudo added to 1500 milligrams of Imfinzi, followed by Imfinzi every four weeks. Treatment was given with embolization as needed. Patients continued Imfinzi, with or without Lenvima depending on their group, until their disease progressed.

The main goal of the trial was to measure progression-free survival in the group receiving Imfinzi, Imjudo, Lenvima and embolization compared with embolization alone. Secondary goals include overall survival and additional progression-free survival comparisons.

Side effects were consistent with known safety profiles

The safety profile of each combination was consistent with the known side effects of each medicine, and no new safety concerns were identified.

Immunotherapy works by helping the body’s immune system recognize and respond to cancer cells. Imfinzi targets a protein called PD-L1, and Imjudo targets a protein called CTLA-4. By blocking these proteins, the treatments are designed to help the immune system better identify and attack cancer cells.

These results will be presented at a forthcoming medical meeting and shared with global regulatory authorities.

References

“Imfinzi plus Imjudo combined with lenvatinib and TACE demonstrated a statistically significant and clinically meaningful improvement in progression-free survival in embolisation-eligible unresectable liver cancer in EMERALD-3 Phase III trial,” news release, AstraZeneca. April 2, 2026.

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