EMERALD-1

Previously, the phase III EMERALD-1 trial showed that a regimen combining transarterial chemoembolization (TACE) with durvalumab (D) and bevacizumab (B) resulted in a statistically significant and clinically meaningful improvement in the primary endpoint of progression-free survival (PFS) compared to TACE alone in patients with hepatocellular carcinoma (HCC) eligible for embolization. During ASCO 2024, Prof Dr Stephen Lam Chan, medical oncologist at the Chinese University of Hong Kong, presented a safety analysis of this study, zooming in on the specific toxicities during the different treatment phases. Prof Dr Jeroen Dekervel (University Hospitals Leuven) looked up Prof Chan to discuss these results.

In EMERALD-1, 616 HCC patients without extrahepatic disease who were not amenable for curative therapy (i.e., surgery, ablation, transplantation) were randomly assigned (1:1:1) to receive TACE alone or in combination with D followed by maintenance therapy with either D or D + B. Compared to TACE alone, the TACE + D + B regimen proved to be associated with a significantly longer progression-free survival (PFS), with 18-month PFS rates of 28.3% and 43.1%, respectively (HR[95%CI]: 0.77[0.61-0.98]; p= 0.032).

The analysis presented at ASCO 2024 confirmed that the combination of TACE + D + B came with a manageable safety profile, both during the TACE-D phase and during the D+B maintenance phase. The type and severity of the toxicities that were observed across the different treatment phases were in line with the known safety profiles of the different agents.

For Prof Chan and Prof Dekervel, these results provide further reassurance on the tolerability of the TACE + D + B regimen evaluated in EMERALD-1. It remains to be seen whether the benefit in PFS that was obtained in this study also translates into a longer overall survival.