TACE Plus Immunotherapy for Liver Cancer: EMERALD-3 Phase 3 Results

Combining chemoembolization (TACE) with immunotherapy for liver cancer has shown benefit in an international phase 3 trial. In EMERALD-3, presented at the 2026 ASCO Annual Meeting and published in The Lancet Oncology, patients with unresectable liver cancer who received TACE together with two immunotherapy drugs (durvalumab and tremelimumab) plus lenvatinib lived a median of 13.0 months without their cancer progressing, compared with 9.8 months with TACE alone, and their risk of progression or death was 30% lower.

Based on the journal article, congress reports and the manufacturer's official announcement, this article explains what EMERALD-3 showed, which liver cancer patients it applies to, how many TACE sessions and side effects there were, and where the approach stands in the US and Japan, in plain language for patients and families.

What is new: the EMERALD-3 phase 3 results

EMERALD-3 is a randomized phase 3 trial run at 177 hospitals in 21 countries. Between March 2022 and November 2024, 1,124 people were screened and 760 were divided into three groups. Group one (293 patients) received TACE plus two immunotherapy drugs and the targeted drug lenvatinib; group two (175 patients) received TACE plus the two immunotherapy drugs; group three (292 patients) received TACE alone, the current standard.

The results were first presented orally at the ASCO Annual Meeting in Chicago on June 1, 2026 (LBA4000) and then published in The Lancet Oncology by Professor Masatoshi Kudo of Kindai University, Japan, and colleagues. The study was led jointly by Memorial Sloan Kettering Cancer Center, Kindai University and Fudan University; 72% of participants were Asian, and Japan was a separate region for randomization.

Why add immunotherapy to TACE?

Transarterial chemoembolization (TACE) is a procedure in which a thin tube is passed from an artery in the groin or wrist into the vessels feeding the liver tumor, and anticancer drug plus embolic material are delivered to cut off the tumor's blood supply. It has long been the standard treatment for intermediate-stage liver cancer when surgery or ablation is not possible.

When the tumor regrows, TACE is often repeated. Principal investigator Dr. Ghassan Abou-Alfa noted that repeated TACE procedures wane in effect over time and risk further decline in liver function. When TACE breaks down tumor tissue, the immune system can recognize the cancer more easily, and immunotherapy helps that immune response last longer — the idea behind the combination.

For how TACE and other artery-based treatments work, see our IVR (interventional radiology) guide and the Y-90 radioembolization overview.

Who is it for?

• Stage: hepatocellular carcinoma that cannot be cured by surgery, ablation or transplant but is suitable for TACE
• Liver function: Child-Pugh class A, with good general condition (ECOG 0–1)
• Extent: no spread outside the liver and no major portal vein invasion (Vp3/Vp4)
• Prior treatment: no previous systemic cancer therapy

Randomization was also stratified by whether tumor burden was within the "up-to-7" criteria, so patients with more or larger tumors were included as well. The tests used to assess liver function and stage before a procedure are covered in tests before liver cancer treatment.

Results: time without progression and tumor response

The primary endpoint was progression-free survival (PFS) — the time patients lived without the cancer growing. The figures below are as reported at the congress and in the official announcement.

Group two was compared with the first 175 patients assigned to TACE alone. Survival figures are from an interim analysis; follow-up for the final overall survival analysis continues.

Put simply, about one in three patients who received immunotherapy with TACE were living without progression at two years, and more patients saw their tumors shrink than with TACE alone. Median overall survival was 39.5 months in group one versus 34.7 months with TACE alone, and the final analysis to confirm this difference statistically is under way.

The number of TACE sessions is worth noting: 40.7% of patients in the TACE-alone group needed three or more sessions, compared with 22.0% (with lenvatinib) and 33.7% in the immunotherapy groups — fewer repeat procedures, which is encouraging for preserving liver function.

Side effects and how they are managed

Adding drugs added side effects. Grade 3–4 adverse events occurred in 62.7% of group one, 48.6% of group two and 18.6% of the TACE-alone group. The most common severe event in group one was high blood pressure (12%), linked to lenvatinib and managed with regular checks and blood pressure medicine. Post-embolization syndrome — fever, abdominal pain and nausea after TACE — occurred in all groups and usually settles within days with pain and fever medicine.

Immunotherapy can occasionally cause inflammation of the thyroid, liver or heart, so regular blood tests are used to catch this early. In the lenvatinib group, doses were often paused or reduced — a routine way of managing side effects while continuing treatment. In the same trial, adding only the two immunotherapy drugs without lenvatinib also gave good results, an option depending on the patient's condition and liver function.

Compared with other TACE combination trials

EMERALD-3 is the third large phase 3 trial in which a TACE combination improved results. The two earlier trials also extended progression-free survival.

Patient groups and designs differ between trials, so the numbers cannot be compared directly.

With three trials pointing the same way, treatment for intermediate-stage liver cancer is broadening from TACE alone to TACE plus systemic therapy. Another combination strategy — adding ablation to TACE — is covered in the TORCH phase 3 trial of TACE plus RFA.

Where is it available?

International patients are often not covered by the host country's public insurance, so check costs and availability directly with the hospital.

AstraZeneca estimates that more than 200,000 people worldwide will be diagnosed with embolization-eligible liver cancer in 2026, over 180,000 of them in China and Japan — which is why interest in these results is high in Japan, where TACE is widely performed. For needle-based local treatments such as radiofrequency ablation, see our RFA guide.

Questions to ask your care team

• Is my liver cancer suitable for TACE, and is my tumor burden within or beyond the up-to-7 criteria?
• Is it safe to combine immunotherapy with TACE given my liver function (Child-Pugh class)?
• Would adding lenvatinib, or only the two immunotherapy drugs, suit me better?
• When would the first TACE take place after starting immunotherapy, and when are the follow-up CT or MRI scans?

To prepare for the consultation, see also five questions to ask before RFA.

Frequently asked questions

How was the immunotherapy given in EMERALD-3?

Tremelimumab 300 mg was given once on day one and durvalumab 1,500 mg every four weeks by intravenous infusion (a schedule called STRIDE). The first TACE was performed at least seven days after the first durvalumab dose.

How much better was it than TACE alone?

Median progression-free survival was 13.0 versus 9.8 months, with a 30% lower risk of progression or death. At two years, 30.4% versus 19.3% were living without progression.

Can I receive this treatment in Japan?

The two-drug immunotherapy combination was approved in Japan in December 2022 for unresectable liver cancer. Its use together with TACE is not yet formally approved, so whether it applies to you should be discussed with the Japanese care team.

Does it mean fewer TACE sessions?

In EMERALD-3, three or more TACE sessions were needed by 40.7% of the TACE-alone group versus 22.0% and 33.7% in the immunotherapy groups. The actual number is decided by the care team based on tumor response.

This article summarizes overseas official sources and papers as general information and is not medical advice. Please discuss treatment choices with a doctor who has examined the patient.