# TACE + immunotherapy/anti-VEGF

Source: https://onco.cc/pairings/tace-plus-systemic/  
OnCo record `tace-plus-systemic` (Pairing). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding drugs to the catheter procedure keeps intermediate-stage liver cancer under control for longer, though a survival gain is still unproven.

## Summary

This combination adds immune checkpoint inhibitors, with or without anti-VEGF therapy, to transarterial chemoembolisation for intermediate-stage hepatocellular carcinoma. TACE releases tumour antigen and induces hypoxia-driven VEGF; PD-1 or PD-L1 blockade exploits the former and anti-angiogenic therapy counters the latter. Three phase 3 trials, EMERALD-1, LEAP-012 and EMERALD-3, all improved progression-free survival, but LEAP-012's final overall survival analysis and EMERALD-1's non-significant trend leave the survival question open. Toxicity roughly doubles with the added drugs, so the trade-off is longer disease control against more side effects without a proven gain in survival.

## Fields

- Kind: Pairing
- Last checked: 2026-09-07
- Pairs: Transarterial chemoembolisation (TACE) + Immune checkpoint inhibitors
- Type: combination
- Rationale: TACE releases antigen and induces hypoxia-driven VEGF; PD-(L)1 blockade exploits the former and anti-VEGF counters the latter.
- Evidence: Three positive phase 3 trials for PFS; no OS benefit shown.

## Sources

- ClinicalTrials.gov NCT03778957: EMERALD-1: https://clinicaltrials.gov/study/NCT03778957
- ClinicalTrials.gov NCT04246177: LEAP-012: https://clinicaltrials.gov/study/NCT04246177

## Connected records

- cancers: [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/), [Intermediate hepatocellular carcinoma (BCLC B)](https://onco.cc/cancers/hcc-intermediate/)
- technologies: [Anti-angiogenic therapy](https://onco.cc/technologies/antiangiogenic/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [Transarterial chemoembolisation (TACE)](https://onco.cc/technologies/tace/)
- trials: [EMERALD-1](https://onco.cc/trials/emerald-1/), [EMERALD-3](https://onco.cc/trials/emerald-3/), [LEAP-012](https://onco.cc/trials/leap-012/)

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