On April 2, 2026, AstraZeneca announced positive high-level results from the Phase III EMERALD-3 trial evaluating Imfinzi (durvalumab) in combination with Imjudo (tremelimumab), lenvatinib and transarterial chemoembolisation (TACE) in patients with unresectable hepatocellular carcinoma (HCC) eligible for embolisation.
Susan Galbraith, Executive Vice President, Oncology Haematology R&D, AstraZeneca, said:
“EMERALD‑3 now shows that bringing the dual immunotherapy STRIDE regimen earlier, alongside TACE and lenvatinib, can further improve outcomes in earlier‑stage liver cancer. This builds on the HIMALAYA Phase III trial data in patients with advanced, unresectable disease, where the STRIDE regimen has already demonstrated durable overall survival benefit. We are discussing these positive data with global regulatory authorities while awaiting the final results from the key secondary endpoints.”
Trial Design and Methods
EMERALD-3 is a randomised, open-label, sponsor-blinded, multicentre, global Phase III trial evaluating a single priming dose of Imjudo 300 mg added to Imfinzi 1500 mg followed by Imfinzi every four weeks (STRIDE regimen) plus TACE with or without lenvatinib versus TACE alone in patients with unresectable HCC eligible for embolisation.
A total of 760 patients were enrolled across 171 centres in 22 countries, including North America, Europe, South America and Asia.
Participants were randomised in a 1:1:1 ratio to:
- Arm A: TACE, Imfinzi, Imjudo and lenvatinib
- Arm B: TACE, Imfinzi and Imjudo
- Arm C: TACE alone
After each arm reached 175 participants, randomisation continued in a 1:1 ratio between Arms A and C until each reached approximately 275 participants. Patients received Imfinzi with Imjudo plus TACE as needed, with or without lenvatinib concurrently, followed by Imfinzi with or without lenvatinib until disease progression.
The primary endpoint was progression-free survival (PFS) for Imfinzi plus Imjudo, lenvatinib and TACE versus TACE alone. Secondary endpoints included overall survival (OS) for the same comparison, as well as PFS and OS for Imfinzi plus Imjudo and TACE versus TACE alone.
Read about Liver Cancer Success Rate on OncoDaily.
Results
Positive high-level results from EMERALD-3 showed that the combination of Imfinzi, Imjudo, lenvatinib and TACE demonstrated a statistically significant and clinically meaningful improvement in progression-free survival compared with TACE alone.
At this interim analysis for overall survival, a key secondary endpoint, the combination also demonstrated a trend toward improved overall survival versus TACE alone.
Although not formally tested at this time, data for the treatment arm evaluating the STRIDE regimen plus TACE versus TACE alone showed strong trends toward improved progression-free survival and overall survival.
The safety profile for each combination was consistent with the known profiles of each medicine, and no new safety findings were identified.
The trial will continue to follow overall survival and other key secondary endpoints in both investigational arms.
Clinical Context
Hepatocellular carcinoma is the most common type of liver cancer. In 2026, more than 200,000 patients with HCC will be eligible for embolisation, a standard-of-care procedure that blocks the blood supply to the tumour and can also deliver chemotherapy directly to the liver.
However, most patients who receive embolisation experience disease progression or recurrence within six to ten months.
Understanding Imfinzi and Imjudo
Durvalumab (Imfinzi) is an immune checkpoint inhibitor that targets PD-L1 (programmed death-ligand 1), a protein expressed on some cancer cells.
Under normal conditions, PD-L1 binds to the PD-1 receptor on T cells, sending an inhibitory signal that reduces immune activity. While this mechanism helps prevent excessive immune responses, tumors can exploit it to evade immune detection.
Durvalumab binds to PD-L1 and blocks its interaction with PD-1 and CD80, effectively releasing this inhibitory signal. As a result, T cells are reactivated and better able to recognize and attack cancer cells.
Rather than directly killing tumor cells, durvalumab enhances the body’s own immune response against cancer.
You can also read Durvalumab (Imfinzi): Uses in Cancer, Side effects, Dosage, Expectations on OncoDaily.
Tremelimumab (Imjudo) targets CTLA-4 (cytotoxic T-lymphocyte–associated protein 4), another key immune checkpoint that regulates T-cell activation.
CTLA-4 normally acts as a brake on the immune system, preventing excessive activation of T cells. However, cancer cells can use this pathway to avoid immune destruction.
By inhibiting CTLA-4, tremelimumab removes this early inhibitory signal, allowing T cells to become fully activated. This activation primarily occurs in the lymph nodes, where immune cells are first primed to recognize tumor antigens.
Within combination approaches such as the STRIDE regimen, tremelimumab acts as an immune “primer,” initiating a strong T-cell response, while durvalumab helps sustain this response within the tumor microenvironment. This dual checkpoint inhibition strategy is designed to produce a deeper and more durable anti-tumor immune effect.
Read about Tremelimumab (Imjudo) Updates 2025: Uses in Cancer, Dosage, Side Effects, Expectations on OncoDaily.
Expert Highlights
Ghassan Abou-Alfa, MD, JD, MBA, PhD (hc), Attending Physician, Professor of Medicine at Memorial Sloan Kettering Cancer Center, and principal investigator in the trial said,
“Dual immunotherapy with durvalumab and tremelimumab in the STRIDE regimen represents a meaningful advance for patients with embolisation-eligible liver cancer, who currently lack systemic treatment options to keep their cancer from progressing or recurring, with a trend of improving survival. EMERALD‑3 shows we can now significantly reduce the risk of disease progression with STRIDE as the immunotherapy backbone alongside lenvatinib and TACE.”
Conclusion
The Phase III EMERALD-3 trial demonstrated that Imfinzi in combination with Imjudo, lenvatinib and TACE significantly improved progression-free survival in patients with embolisation-eligible unresectable HCC, with a trend toward improved overall survival at interim analysis.
These data will be presented at a forthcoming medical meeting and are being shared with global regulatory authorities.
Full details are available in the official AstraZeneca website.