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EMERALD-3 — Durvalumab + tremelimumab (STRIDE) ± lenvatinib + TACE, unresectable embolization-eligible HCC, locoregional/1L

Abstract: LBA4000 · Session: Gastrointestinal Cancer (Hepatobiliary), 2026 ASCO Annual Meeting · Presenter: Ghassan K. Abou-Alfa, MD (Memorial Sloan Kettering Cancer Center) · Embargo: per ASCO LBA release

At a glance

  • Sponsor: AstraZeneca
  • PI / presenter: Ghassan K. Abou-Alfa, MD — Memorial Sloan Kettering Cancer Center (principal investigator / presenter)
  • NCT ID: NCT05301842
  • Phase: 3
  • Design: Randomized, open-label, multicenter (171 centers, 22 countries); three arms — STRIDE + lenvatinib + TACE vs STRIDE + TACE vs TACE alone
  • N: 760 (STRIDE + lenvatinib + TACE n=293; STRIDE + TACE n=175; TACE alone n=292)
  • Primary endpoint(s): Progression-free survival (PFS) for STRIDE + lenvatinib + TACE vs TACE alone
  • Comparator: TACE alone
  • Indication: Unresectable, embolization-eligible hepatocellular carcinoma (eeHCC)
  • Line: Locoregional / first systemic-plus-locoregional therapy

Headline result

In the planned analysis, STRIDE (single tremelimumab regular-interval durvalumab) plus lenvatinib plus TACE significantly improved median PFS to 13.0 vs 9.8 months vs TACE alone (HR 0.70), a 30% reduction in the risk of progression or death. The STRIDE + TACE arm (without lenvatinib) also improved PFS, 12.9 vs 8.1 months (HR 0.71). At an interim OS analysis (~40% maturity), STRIDE + lenvatinib + TACE showed an early favorable trend (median OS 39.5 vs 34.7 mo; HR 0.84; 24-mo OS 66.9% vs 61.5%), and STRIDE + TACE vs TACE showed median OS not reached vs 32.9 mo (HR 0.70; 24-mo OS 68.0% vs 57.8%); OS remained immature and follow-up is ongoing. P-values and confidence intervals were not detailed in available trade-press coverage at time of writing.

Mechanism / class

STRIDE = a single priming dose of tremelimumab (anti–CTLA-4) added to regular-interval durvalumab (anti–PD-L1), the regimen approved in unresectable HCC on the HIMALAYA trial. Lenvatinib is an oral multikinase/VEGFR-directed TKI. TACE is locoregional transarterial chemoembolization. EMERALD-3 tests whether layering dual checkpoint blockade ± antiangiogenic TKI onto TACE deepens locoregional control in embolization-eligible disease.

Discussant takeaway

Not captured in available coverage at time of writing; PI Abou-Alfa framed the result as establishing STRIDE as an immunotherapy backbone alongside lenvatinib and TACE for embolization-eligible HCC.

Practice-changing?

Pending. EMERALD-3 is the second positive immunotherapy-plus-TACE phase 3 in embolization-eligible HCC (after EMERALD-1, durvalumab + bevacizumab + TACE). The PFS gain is statistically significant and clinically meaningful, but OS is immature and a clear OS benefit will likely be required for practice change and regulatory filing in this curative-intent-adjacent setting. The STRIDE + TACE (no lenvatinib) arm performing comparably on PFS raises questions about lenvatinib's marginal contribution.

  • Other ASCO 2026 trials: (HCC/GI — none yet on this site)
  • JPM 2026: AstraZeneca oncology pipeline — ../../jpm-2026/index.md

Sources

  • ASCO Meeting Library (LBA4000): https://www.asco.org/abstracts-presentations/259300/
  • CancerNetwork: https://www.cancernetwork.com/view/emerald-3-durvalumab-combo-improves-pfs-in-embolization-eligible-hcc
  • OncoDaily: https://oncodaily.com/oncolibrary/gastrointestinal-oncology/emerald-3
  • Targeted Oncology: https://www.targetedonc.com/view/durvalumab-tremelimumab-combo-improves-pfs-in-unresectable-hcc
  • AstraZeneca press release: https://www.astrazeneca.com/media-centre/press-releases/2026/imfinzi-plus-imjudo-combined-with-lenvatinib-and-tace-reduced-the-risk-of-disease-progression-or-death-in-emerald-3-phase-iii-trial.html
  • Fierce Pharma: https://www.fiercepharma.com/pharma/asco-astrazenecas-imfinzi-imjudo-duo-shines-earlier-stage-liver-cancer-win