Background: Hepatic transarterial embolization (HAE) is an effective loco-regional therapy for neuroendocrine tumor (NET) management. Systemic targeted therapies, such as everolimus and sunitinib, are typically held 2-4 weeks prior to and after procedures. The safety of concurrent use of everolimus with HAE has been previously reported (GI-ASCO). HAE induces anoxic injury while everolimus effects cell growth, proliferation and survival. Combining these two modalities may result in clinical synthetic lethality effectively debulking significant hepatic disease and/or delay progression. Historically bland HAE has a median hepatic PFS of ~9 months. In this study, the clinical efficacy of evero-embo is examined. Methods: A review of clinical and radiographic data was conducted for all sequential patients who underwent evero-embo between September 2016 and April 2018 at the University of Kentucky Markey Cancer Center. An independent radiologist performed RECIST measurements. Patients were required to have had systemic everolimus for ≥ 1 month prior to embolization in order to be included in this study and be on everolimus immediately post procedure. Patients with at least 12 months post procedure follow up were included for efficacy review. Results: A total of 51 HAEs with concurrent systemic everolimus were performed in 34 NET patients. Twenty one of 24 patients were noted to have a partial response. Rest had stable disease. Hepatic progression was not observed. Twenty-one of the 34 patients have had 12 or more months of follow up post procedure (median of 17 months). None of these 21 patients have had hepatic progression. Conclusions: Evero-embo results in a partial response rate of 62% and may have significant antitumor activity when compared to bland hepatic artery embolization in NET patients. With a median follow-up of 17 mos, hepatic progression has not occurred in any patient. Additional follow up is necessary to compare the median hepatic PFS of evero-embo to the historical drug-eluting bead HAE PFS.