Phase III Data from Durvalumab Combo Show Benefit in Early Liver Cancer

AstraZeneca reported that its phase 3 trial (EMERALD-3) met the primary endpoint. In the trial, durvalumab (brand name Imfinzi) plus tremelimumab (brand name Imjudo), lenvatinib, and transarterial chemoembolization (TACE) demonstrated a statistically significant and clinically meaningful improvement in progression-free survival (PFS) compared with TACE alone in patients with unresectable hepatocellular carcinoma (HCC) eligible for embolization, the company announced on April 2, 2026.¹

At an interim analysis, the combination regimen also showed a trend toward improved overall survival (OS), a key secondary endpoint, though the company said follow-up is ongoing. Patients received the single tremelimumab regular interval durvalumab (STRIDE) regimen, consisting of single-dose tremelimumab plus regular-interval durvalumab, with or without lenvatinib and administered before and alongside TACE.

“Dual immunotherapy with durvalumab and tremelimumab in the STRIDE regimen represents a meaningful advance for patients with embolization-eligible liver cancer, who currently lack systemic treatment options to keep their cancer from progressing or recurring, with a trend of improving survival,” said Ghassan Abou-Alfa, MD, PhD(hc), attending physician, professor of Medicine at Memorial Sloan Kettering Cancer Center, and principal investigator in the phase 3 trial, in a company press release.¹ “EMERALD‑3 shows we can now significantly reduce the risk of disease progression with STRIDE as the immunotherapy backbone alongside lenvatinib and TACE.”

Why is earlier integration of immunotherapy a strategic shift in liver cancer?

HCC remains a high-burden malignancy and the most common form of liver cancer, with more than 200,000 patients globally eligible for embolization annually.² Despite its role as a standard-of-care procedure, TACE alone is associated with frequent disease progression or recurrence within six to ten months, highlighting the need for more durable treatment strategies.

Historically, systemic immunotherapies have been deployed primarily in advanced or metastatic HCC. By moving the TACE approach into earlier, embolization-eligible settings, EMERALD-3 builds on prior evidence, including a previous phase 3 trial (HIMALAYA), which established the STRIDE regimen as a standard in advanced unresectable HCC.

This shift aligns with the broader industry trend toward combining locoregional and systemic therapies to enhance outcomes.³ By introducing immunotherapy before or alongside embolization, investigators aim to both control tumor burden locally and activate systemic anti-tumor immune responses, potentially reducing recurrence risk.¹

According to AstraZeneca, the addition of lenvatinib, a multikinase inhibitor, further supports a multi-modal approach targeting tumor angiogenesis and immune evasion simultaneously. Together, these mechanisms may help overcome the limitations of TACE monotherapy, which does not address underlying tumor biology beyond localized intervention.

What are the broader implications for oncology treatment strategies?

The EMERALD-3 results strengthen the biopharmaceutical industry’s growing emphasis on combination regimens that integrate immunotherapy, targeted therapy, and procedural interventions.³ This approach aligns with evolving oncology strategies aimed at intervening earlier in disease progression, where there is greater potential to alter long-term outcomes.

The data reinforce the expanding role of durvalumab and tremelimumab across multiple tumor types and stages, particularly within gastrointestinal cancers, according to AstraZeneca. The company is advancing a broad immuno-oncology pipeline of combination strategies to extend survival benefits beyond late-stage settings.

If confirmed in final OS analyses and subsequent regulatory discussions, EMERALD-3 could impact the standard of care for embolization-eligible HCC. Such impact could position immunotherapy-based combinations as a new backbone in earlier-stage disease. More broadly, these findings indicate continued momentum toward integrated, multi-modality cancer care designed to improve response durability and delay progression in high-risk populations.

References

1. AstraZeneca. 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. Published April 2, 2026. Accessed April 3, 2026. https://www.astrazeneca.com/media-centre/press-releases/2026/imfinzi-imjudo-improves-pfs-in-early-liver-cancer.html
2. AstraZeneca. Investor Relations Epidemiology Spreadsheet. Top 8 Countries. Accessed April 3, 2026. https://www.astrazeneca.com/investor-relations.html
3. Li X, Wang Y, Ye X, Liang P. Locoregional combined with systemic therapies for advanced hepatocellular carcinoma: an inevitable trend of rapid development. Front. Mol. Biosci. 2021; 8-2021. doi: 10.3389/fmolb.2021.635243