{"entity":{"id":"emerald-1","kind":"trial","name":"EMERALD-1","aka":[],"tldr":"The first trial to show that adding immunotherapy and an anti-VEGF drug to TACE delays progression in intermediate-stage liver cancer.","summary":"EMERALD-1, trial NCT03778957 sponsored by AstraZeneca and reported in 2024, was the first trial to show that adding immunotherapy and an anti-VEGF drug to transarterial chemoembolisation delays progression in intermediate-stage hepatocellular carcinoma. It randomised 616 embolisation-eligible patients to TACE with durvalumab, with or without bevacizumab, or TACE with placebo, met its primary progression-free survival endpoint for the three-way combination, and overall survival trended favourably but was not statistically significant at follow-up, as published in the Lancet in 2025. OnCo links it to TACE as a technology and term, durvalumab and the pairing of TACE with immunotherapy and anti-VEGF drugs. Whether delaying progression after TACE translates into longer life is the open question, and LEAP-012 suggests it may not.","status":"mixed","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT03778957","url":"https://clinicaltrials.gov/study/NCT03778957"},{"label":"Lancet","url":"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02551-0/abstract"}],"tags":[],"related":[],"cancers":["hcc","hcc-intermediate"],"sections":[],"technologies":["tace"],"targets":[],"drugs":["durvalumab"],"companies":["astrazeneca"],"institutions":[],"pathways":[],"terms":["tace-term"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT03778957","phase":"3","setting":"Embolisation-eligible unresectable HCC: TACE + durvalumab ± bevacizumab vs TACE + placebo","sponsor":"AstraZeneca","result":"PFS HR 0.77; OS HR 0.80, not significant.","started":"2018-11-30","startedType":"actual","yearReported":2024,"enrolled":616,"enrolledBasis":"randomised","enrolledNote":"ClinicalTrials.gov lists 724 participants (actual); the Lancet 2025 paper reports 887 patients screened and 616 randomised (204, 207 and 205 across the three arms).","outcomes":[{"endpoint":"Progression-free survival","primary":true,"unit":"months","arms":[{"name":"TACE + durvalumab + bevacizumab","value":15},{"name":"TACE + placebo","value":8.2}],"hr":0.77,"ci":[0.61,0.98]},{"endpoint":"Overall survival","arms":[{"name":"TACE + durvalumab + bevacizumab"},{"name":"TACE + placebo"}],"hr":0.8,"ci":[0.57,1.11]}]},"route":"/trials/emerald-1/","neighbours":{"cancer":[{"id":"hcc","kind":"cancer","name":"Hepatocellular carcinoma","route":"/cancers/hcc/"},{"id":"hcc-intermediate","kind":"cancer","name":"Intermediate hepatocellular carcinoma (BCLC B)","route":"/cancers/hcc-intermediate/"}],"technology":[{"id":"tace","kind":"technology","name":"Transarterial chemoembolisation (TACE)","route":"/technologies/tace/"}],"drug":[{"id":"durvalumab","kind":"drug","name":"Durvalumab","route":"/drugs/durvalumab/"}],"company":[{"id":"astrazeneca","kind":"company","name":"AstraZeneca","route":"/companies/astrazeneca/"}],"term":[{"id":"tace-term","kind":"term","name":"TACE (transarterial chemoembolisation)","route":"/terms/tace-term/"}],"pairing":[{"id":"tace-plus-systemic","kind":"pairing","name":"TACE + immunotherapy/anti-VEGF","route":"/pairings/tace-plus-systemic/"}],"paper":[{"id":"paper-emerald-1-lancet-2025","kind":"paper","name":"EMERALD-1: durvalumab with or without bevacizumab added to transarterial chemoembolisation for embolisation-eligible hepatocellular carcinoma","route":"/key-papers/paper-emerald-1-lancet-2025/"}],"roadmap":[{"id":"surgery-roadmap","kind":"roadmap","name":"Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work","route":"/roadmaps/surgery-roadmap/"}]}}