THE ADDITION of an immunotherapy-based combination to trans-arterial chemoembolisation (TACE) may improve progression-free survival in patients with the most common form of liver cancer, according to research presented at the American Society of Clinical Oncology (ASCO) Gastrointestinal (GI) Cancers Symposium 2024 in San Francisco, California, USA, which took place between 18th–20th January.
Previous research has suggested that TACE could work well in combination with immunotherapy and anti-vascular endothelial growth factor, a protein which can promote blood flow to a tumour when expressed in tumours. The EMERALD-1 study, conducted by Riccardo Lencioni, Pisa University School of Medicine, Italy, and colleagues, involved using TACE, as well as these other anticancer therapies, to treat 616 patients with embolisation-eligible, unresectable hepatocellular carcinoma. These patients were treated with durvalumab (an immunotherapy), bevacizumab (anti-vascular endothelial growth factor), and TACE; durvalumab plus TACE; or TACE alone.
Results demonstrated that those treated with the combination of durvalumab, bevacizumab, and TACE had a significant improvement in progression-free survival compared to patients treated with TACE alone. Additionally, the objective response rate and time to progression were also improved in the group treated with durvalumab, bevacizumab, and TACE. There was no significant difference in progression-free survival between the durvalumab and TACE group versus the group treated only with TACE.
Furthermore, Grade III–IV treatment-related side effects were experienced by 32.5% of patients in the durvalumab, bevacizumab, and TACE group; 15.1% in the durvalumab plus TACE group; and 13.5% in the TACE group. Treatment was discontinued in 8.4% of the durvalumab, bevacizumab, and TACE group; 4.3% of the durvalumab and TACE group; and 3.5% of the TACE group.
This research has the potential to alter the global standard of care for patients with hepatocellular carcinoma, which for more than 20 years has been treatment with TACE alone. Patients treated with TACE alone often experience rapid disease progression or reoccurrence within the first year, compared to those treated with TACE and other anticancer therapies. Lencioni and team will continue to follow patients on the EMERALD-1 trial for the secondary endpoint of overall survival.
