The first Emerald gleams for Astra

AstraZeneca’s Imfinzi plus Imjudo has cautiously challenged Roche’s Tecentriq plus Avastin in front-line liver cancer, and today the UK firm upped the ante: Emerald-1, testing Imfinzi plus transarterial chemoembolisation (TACE) and Avastin, has been toplined positive for progression-free survival versus TACE alone. Of course, nothing is yet known about the absolute benefit seen, and it's unclear whether Astra would file based on these data alone; the group says Emerald-1 is continuing to its secondary OS readout. And nothing has been said about the study’s third cohort, Imfinzi plus TACE alone, hinting at a lack of success here. Imfinzi plus Imjudo is approved for first-line liver cancer based on results from the Himalaya study, which on a cross-trial basis failed to match Roche’s Imbrave-150. In the second-line setting Keytruda is approved, but Opdivo’s accelerated nod was pulled in 2021, two years after the failure of the front-line Checkmate-459 study. Meanwhile, Keytruda’s own first-line filing, in combination with Eisai’s Lenvima, got a US complete response letter because the uncontrolled Keynote-524 trial gave it insufficient backing. That FDA decision turned out to be well founded when the same combo then failed to beat Lenvima in the phase 3 Leap-002 study.

Selected first-line liver cancer trials

Source: OncologyPipeline, Lancet, ESMO & prescribing information.