High-Dose EPA Linked to Longer Survival After Liver Surgery
The EMT2 trial found 62.0% five-year survival with EPA versus 45.1% with placebo in patients operated on for colorectal cancer that had spread to the liver.
Patients who took high-dose eicosapentaenoic acid (EPA), an omega-3 fatty acid, before and after surgery for colorectal cancer liver metastases lived longer than those given placebo. The phase 3 EMT2 trial reported the result at the ESMO Congress 2026.
Surgery to remove bowel cancer that has spread to the liver can allow long-term survival, but the cancer often returns. Earlier laboratory and observational work had suggested EPA might act against colorectal cancer, and a phase 2 trial pointed to a possible survival benefit.
How the trial worked
EMT2 was randomized, double-blind and placebo-controlled. It enrolled 418 patients scheduled for liver resection with curative intent at 13 UK hepatobiliary surgery centers. They received either 4g of EPA daily, as the prescription drug icosapent ethyl, or a mineral oil placebo.
Treatment began at least one day before surgery and was planned to continue for two to four years, even if the cancer progressed. About 20% of patients in each group received adjuvant chemotherapy.
Results
Estimated five-year overall survival was 62.0% with EPA and 45.1% with placebo. EPA was linked to a 32% lower hazard of death (hazard ratio 0.68; 95% confidence interval 0.48-0.96; p = 0.03). Median overall survival had not been reached with EPA and was 59.0 months with placebo.
The result held in the per-protocol analysis and after adjustment for diabetes, which was more common in the EPA group at baseline (16% versus 8%). Median progression-free survival was similar in both groups, at 13.5 versus 12.9 months.
EPA caused no excess adverse events, bleeding or atrial fibrillation compared with placebo, and quality of life was not affected.
"The overall survival benefit seen with EPA in EMT2, if confirmed in other studies, is clinically meaningful," said lead author Mark Hull of the Leeds Institute of Medical Research, University of Leeds. He suggested the effect might reflect the body's response to cancer, including cachexia.
Source: News-Medical