In a phase 3 EMT2 trial, high-dose prescription EPA (icosapent ethyl, 4 grams daily) given around liver surgery for colorectal cancer with liver metastases showed a higher estimated five-year overall survival of 62% versus 45.1% with placebo, though progression-free survival did not significantly improve (13.5 months vs 12.9 months).

The EMT2 trial enrolled 418 patients across 13 centers in England and Wales between 2018 and 2023 and was presented at the ESMO 2026 Congress in Madrid.

The primary endpoint, progression-free survival, was not met in the intent-to-treat population (median PFS 13.5 months with IPE vs 12.9 months with placebo; adjusted HR 0.89; p=0.329).

Safety aligned with known IPE effects, with no new safety signals beyond established risks such as atrial fibrillation and bleeding; careful monitoring advised for patients on anticoagulants or antiplatelets.

The observed OS benefit without PFS improvement raises questions about potential delayed anti-tumor immune effects or other mechanisms, signaling the need for further analyses and studies.

Experts view the OS signal as potentially clinically meaningful if confirmed, but emphasize caution given the unchanged PFS and the need for confirmatory results before altering practice.

Overall interpretation remains cautious; results should not yet change routine clinical recommendations pending further validation.

Context from prior phase 2 data suggests EPA may boost immune response or have systemic effects beyond slowing tumor growth.

Practical guidance: patients should not self-initiate high-dose omega-3 therapy around cancer surgery; discuss with oncologist and surgeon, noting FDA warnings about atrial fibrillation and bleeding with high-dose EPA; prescription EPA differs from OTC fish oil and coverage varies.

Limitations include that results have not yet been published in a peer-reviewed journal; some data such as follow-up duration and death counts by group were not fully disclosed; study funded by Yorkshire Cancer Research with Amarin supplying the EPA and placebo, though company involvement in design/conduct was limited.

Trial leadership and Amarin executives stressed the potential significance of OS improvement and ongoing exploration of IPE’s role beyond cardiovascular disease, including patent protection through 2039 in Europe.

The survival gain did not correspond with a delay in cancer recurrence or progression, indicating the OS benefit is not due to slowed tumor growth.