Outcomes by transarterial chemoembolization (TACE) modality from participants (pts) with embolization-eligible hepatocellular carcinoma (HCC) treated with durvalumab (D) + bevacizumab (B) + TACE and placebos (PBO) + TACE: EMERALD-1 subgroup analysis.
Authors: Heo Jeong , Okusaka Takuji , Yoon Jung-Hwan , Sangro Bruno , Chan Stephen Lam , Erinjeri Joseph P. , Matos Marco , Decaens Thomas , Chen Eric Xueyu , Beg Muhammad S. , Matilla Ana Maria , Tuyet Phuong Le Thi , Griffin Rebecca , Udoye Stephanie I. , Indiviglio Sandra , Kudo Masatoshi 
Published: January 2025

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Background:
EMERALD-1 (NCT03778957) met its primary endpoint, showing improved progression-free survival (PFS) in pts with locoregional HCC treated with D + B + TACE versus PBO + TACE (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.61–0.98). This analysis assessed the impact of TACE modality (conventional TACE [cTACE] or drug-eluting bead [DEB]-TACE) on efficacy and safety outcomes.
Methods:
Pts in this analysis received D (1500 mg) or PBO for D (Q4W) plus cTACE or DEB-TACE (investigator choice; TACE modality was a stratification factor). After completing the last TACE, pts received D (1120 mg) + B (15 mg/kg) or PBO for D + B (Q3W). PFS, time to progression (TTP), and overall response rate (ORR; BICR per RECIST v1.1) with D + B + TACE and PBO + TACE (intent-to-treat population) are reported by TACE modality. Safety was assessed in the safety analysis set (pts received ≥1 dose of study treatment [tx], regardless of randomization).
Results:
Overall, 59.3% of pts received cTACE and 40.7% received DEB-TACE in the D + B + TACE arm; similarly, 58.5% of pts received cTACE and 41.5% received DEB-TACE in the PBO + TACE arm. Most pts received 1 or 2 TACE procedures in both cTACE (60% in D + B + TACE arm; 67.2% in PBO + TACE arm) and DEB-TACE groups (55.6% in D + B + TACE arm; 53.6% in PBO + TACE arm). Baseline characteristics in the cTACE and DEB-TACE groups were similar, with some differences in the relative distribution of BCLC, HAP, and tumor burden (BCLC Score A; 29.0% vs 17.9%: HAP Score A; 36.5% vs 25.0%: tumor burden within up-to-7 criteria; 56.4% vs 37.5%, respectively). Baseline characteristics were generally well balanced across tx arms within the cTACE and DEB-TACE groups. PFS, TTP, and ORR improved with D + B + TACE versus PBO + TACE, regardless of TACE modality (Table). In the D + B + TACE and PBO + TACE arms, max Grade 3–4 adverse events possibly related to study tx were reported by 25/100 (25.0%) and 3/116 (2.6%) pts in the cTACE group, and 16/54 (29.6%) and 9/84 (10.7%) pts in the DEB-TACE group, respectively.
Conclusions:
Overall, pts receiving D + B + TACE had improved PFS, TTP, and ORR versus PBO + TACE regardless of TACE modality. Safety was manageable with both cTACE and DEB-TACE.
Clinical trial information: NCT03778957
.

D + B and
cTACE
(n=121)

PBO and
cTACE
(n=120)

D + B and
DEB-TACE
(n=83)

PBO and
DEB-TACE
(n=85)

Median (95% CI) PFS, months
19.4 (12.4–22.3)
11.1 (7.2–14.0)
11.1 (7.2–14.2)
6.7 (5.0–7.3)

PFS HR (95% CI)
0.80 (0.59–1.10)

0.74 (0.51–1.06)

Median (95% CI) TTP, months
22.3 (19.4–27.7)
13.6 (9.2–16.6)
15.0 (11.1–22.4)
6.9 (5.1–11.1)

TTP HR (95% CI)
0.70 (0.49–0.98)

0.55 (0.36–0.83)

Pts with measurable disease at baseline, n
119
119
83
84

ORR, n (%) pts with response*
62 (52.1)
43 (36.1)
26 (31.3)
17 (20.2)

ORR, odds ratio (95% CI)
1.93 (1.15–3.27)

1.80 (0.89–3.69)

*Includes confirmed complete or partial response.