Transarterial chemoembolization (TACE) is the standard-of-care treatment for patients with intermediate-stage hepatocellular carcinoma (HCC) who are not candidates for resection, ablation or transplantation, although disease recurrence is common. Now, early data from two phase III trials demonstrate that the addition of both an immune-checkpoint inhibitor (ICI) and an anti-angiogenic agent to TACE improves patient outcomes.

Both trials involved patients with Barcelona Clinic Liver Cancer stage A–C non-metastatic HCC amenable to TACE. In LEAP-012, 480 patients were randomly allocated (1:1) to TACE (with a maximum of two treatments per tumour) and either pembrolizumab plus lenvatinib or double placebo. In EMERALD-1, 616 patients were randomly allocated (1:1:1) to TACE (1–4 procedures) and either durvalumab plus bevacizumab, durvalumab plus placebo or placebo alone. The primary end point of both trials was progression-free survival (PFS).