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Immunotherapy combined with TACE or Y-90: what the trials show | CION Cancer Clinics
Immunotherapy is being combined with TACE or Y-90 for liver cancer that is confined to the liver, mostly inside clinical trials. Early large trials suggest the cancer may take longer to grow again, but the effect on living longer is still being studied. This page explains the combinations, who they may suit, who they do not, and what to ask your oncologist. At CION Cancer Clinics, a multidisciplinary tumour board weighs your liver function and your scans before recommending any treatment.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- Is immunotherapy given together with TACE or Y-90 now?
- Which combinations are researchers studying?
- What happens if a combination is recommended or offered in a trial?
- What do the words in a trial explanation mean?
- Who is this combination not suitable for?
- What this page cannot tell you
- Common questions about immunotherapy with TACE or Y-90
The short answer
Is immunotherapy given together with TACE or Y-90 now?
Sometimes, but mostly inside clinical trials or after careful tumour board discussion. The idea is simple: treat the tumour directly through its blood supply, then use immunotherapy to help the body keep the cancer in check for longer.
This page is about primary liver cancer, called hepatocellular carcinoma (HCC), which starts in the liver itself. If your cancer began in the bowel, breast or elsewhere and spread to the liver, the trials and the advice are different. Your own cancer team, or the page on TACE for liver metastases, is the better place to start.
Why doctors are interested
TACE (chemoembolisation, which blocks the tumour's blood supply and delivers chemotherapy into it) and Y-90 (also called TARE, tiny radioactive beads placed in the tumour's arteries) both kill a large part of a tumour. As the tumour breaks down, it may release signals that the immune system can recognise. Immunotherapy may make that response stronger. In theory, the two treatments help each other.
What the trials have shown so far
Large trials adding immunotherapy, sometimes with a second drug, to TACE have reported that the cancer took longer to grow again. Whether people also live longer is still being studied. For Y-90, the evidence is earlier and smaller. That is why this combination is not yet routine care for everyone.
A longer time before the cancer grows is a real benefit, but it is not the same as living longer. Ask which one a trial measured.What is being tested
Which combinations are researchers studying?
The combinations fall into a few groups. Your oncologist can tell you which, if any, is relevant to your scan and your liver.
TACE plus immunotherapy
The most studied pairing. An immunotherapy drug such as durvalumab or pembrolizumab is given alongside or after TACE, often with a second medicine that targets blood vessel growth, such as bevacizumab or lenvatinib.
Usually studied in
- Intermediate-stage cancer, BCLC stage B
- Tumours confined to the liver
- People whose liver still works well
Y-90 plus immunotherapy
Radioembolisation is paired with an immunotherapy drug. Radiation is thought to be good at alerting the immune system, which is why researchers are interested. Results so far come from smaller and earlier trials.
Immunotherapy before TACE or Y-90
Some trials start with systemic treatment to shrink the cancer first, then treat what remains directly. The hope is to bring a larger cancer within reach of local treatment.
Combinations for portal vein involvement
When the cancer has grown into the portal vein, the main vein carrying blood into the liver, some teams study Y-90 or radiation with immunotherapy. This is still an area of active research.
Each combination has its own side effects. Two treatments together usually means more to watch, not less.Not sure whether this applies to you?
Ask an oncologistHow it usually runs
What happens if a combination is recommended or offered in a trial?
The tumour board reviews everything
Your scans, blood tests and liver function are discussed by oncologists, radiologists and liver specialists together. At CION this is the liver tumour board. They decide whether local treatment, systemic treatment or both make sense for you.
Checks before anything starts
Hepatitis B or C must be controlled, because immunotherapy can trouble an active infection. Varices (swollen veins in the food pipe) may need checking with an endoscopy, especially before drugs like bevacizumab that raise bleeding risk.
The local treatment
TACE or Y-90 is done by an interventional radiologist. CION coordinates these procedures through NABH-accredited partner hospitals, and your team will tell you where it takes place.
The immunotherapy
Immunotherapy is given as a drip at a CION centre on a schedule your oncologist sets. In a trial, the timing follows the trial plan.
Scans to measure response
Follow-up scans show whether the tumour has shrunk or stopped taking up contrast. Blood tests watch your liver closely after each treatment.
On a trial leaflet
What do the words in a trial explanation mean?
- Locoregional treatment
- Treatment aimed only at the liver, such as TACE, Y-90 or ablation, rather than medicine that travels through the whole body.
- Systemic treatment
- Medicine that reaches the whole body through the blood, such as immunotherapy, targeted tablets or chemotherapy.
- Progression-free survival
- How long people in a trial went before the cancer grew or spread. It is a common trial measure, and it is not the same as overall survival.
- Overall survival
- How long people in a trial lived, whatever happened to the cancer. This is the measure that takes longest to answer.
- Randomised
- A computer decides which group you join, so the comparison is fair. Neither you nor your doctor chooses.
- Phase 3
- A large trial comparing a new approach against the current standard. Read more on what trial phases mean.
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Did you know
A trial that reports a "positive" result has usually met the one main question it set out to answer. That question may be how long before the cancer grows, not how long people live. Always ask which question was answered.
Not for everyone
Who is this combination not suitable for?
Combining two treatments asks more of the liver and the body. Several groups are usually not suitable, inside or outside a trial.
When the liver is already struggling
People with poor liver function, such as advanced Child-Pugh B or Child-Pugh C cirrhosis, jaundice or fluid in the abdomen that keeps coming back, are usually not offered TACE or Y-90 at all. Adding immunotherapy does not change that. The page on when TACE is not safe explains why.
When immunotherapy itself is risky
People with an active autoimmune disease, an organ transplant, or hepatitis B that is not controlled with antiviral tablets need extra caution. Some are not suitable at all. Large untreated varices and recent bleeding are further reasons for care.
When the cancer has spread outside the liver
If cancer is already in the lungs, bones or lymph nodes, local treatment to the liver alone does little. Systemic treatment is then usually the main plan, as described in systemic treatment options.
Very small cancers that can be removed, ablated or transplanted are also not the target group. Those treatments are aimed at being curative, and adding experimental drugs would not usually help.
Being straight with you
What this page cannot tell you
It cannot tell you whether a combination is right for you. That depends on the size and number of tumours, the portal vein, your liver function, your hepatitis status and your general fitness. Only a team that has seen your scans and blood results can weigh those together.
It cannot tell you which trials are open
Trials open and close often, and many are not running in India at a given time. Even where a drug is available in India, using it alongside TACE or Y-90 may not be an approved or standard use. It may only be possible within a trial. Your oncologist can check the Clinical Trials Registry of India with you.
It is written to inform, not to recruit
CION does not use this page to enrol anyone in a trial. Joining a trial is always your choice, and saying no never affects the care you receive. If you are weighing it up, read should I join a liver cancer trial.
If someone offers you a combination treatment, ask for the reason in writing and bring it to your oncologist.Questions we are asked
Common questions about immunotherapy with TACE or Y-90
Is TACE with immunotherapy better than TACE alone?
In large trials, adding immunotherapy and a second drug to TACE delayed the cancer growing again. Whether it helps people live longer is still being answered. For some people the extra side effects may not be worth it. Your oncologist can explain how the evidence applies to your situation.
Is this combination available in India?
The individual treatments are used in India. The combination is not yet routine care, and using the drugs together with TACE or Y-90 may fall outside standard approved use. In many cases it is only possible inside a trial. Ask your oncologist what is available now.
Does CION do TACE or Y-90 itself?
No. CION's tumour board plans the treatment and CION gives immunotherapy at its centres. TACE and Y-90 are done by interventional radiologists at NABH-accredited partner hospitals, which CION coordinates. Your team will tell you where the procedure takes place.
Are the side effects worse with two treatments?
Often there is more to watch. TACE can cause pain, fever and tiredness for some days. Immunotherapy can cause inflammation in the liver, gut, skin or glands. Your team checks your blood often, so problems can be spotted early. See immune hepatitis from immunotherapy.
Can I have it if I have hepatitis B?
Often yes, provided the virus is controlled with antiviral tablets before and during treatment. Hepatitis B is controlled, not removed, so the tablets continue. A hepatologist or physician manages the antiviral side. Your oncologist will check your virus tests before starting.
Does a trial pay for my treatment?
Trials usually pay for the study drug and some tests, but rarely everything. Travel, stays and standard care may not be covered. Ask for the costs in writing before you sign. Read who pays in a clinical trial for the questions to ask.
Can I leave a trial once I have started?
Yes, at any time and for any reason. You do not have to explain. Your doctors will then plan the most suitable standard treatment for you. Leaving a trial never means losing access to care.
How do I ask whether this is right for me?
Bring your latest scan report, CD and blood results to your oncologist. Ask whether your case has gone to a tumour board, and whether any combination or trial fits. You can also call the CION helpline to arrange a consultation or second opinion.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- American Cancer Society — Immunotherapy for Liver Cancer
- American Cancer Society — Embolization Therapy for Liver Cancer
- American Cancer Society — What's New in Liver Cancer Research?
- Clinical Trials Registry - India — Clinical Trials Registry - India
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
TACE combined with tablets or immunotherapyHow the combination fits into everyday treatment planningNewer combinations being studiedThe wider picture of drug combinations under researchHow to find liver cancer trials in IndiaWhere to look and how to check a trial is genuineTreatment for intermediate liver cancerThe standard options for the stage most trials target
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Wondering whether a combination fits your scan?
Share your scans and blood reports and a CION oncologist will explain which treatments, including any trials, genuinely fit your liver and your cancer. One helpline serves every CION centre.