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An Investigational Immuno-therapy Study of Nivolumab Compared to Sorafenib as a First Treatment in Patients With Advanced Hepatocellular Carcinoma

A Randomized, Multi-center Phase III Study of Nivolumab Versus Sorafenib as First-Line Treatment in Patients With Advanced Hepatocellular Carcinoma (CheckMate 459: CHECKpoint Pathway and nivoluMAb Clinical Trial Evaluation 459)

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02576509
Enrollment
743
Registered
2015-10-15
Start date
2015-12-07
Completion date
2024-02-07
Last updated
2025-02-17

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Hepatocellular Carcinoma

Brief summary

The purpose of this study is to determine if nivolumab or sorafenib is more effective in the treatment of Advanced Hepatocellular Carcinoma.

Interventions

DRUGNivolumab

Specified Dose on Specified Days

DRUGSorafenib

Specified Dose on Specified Days

Sponsors

Ono Pharmaceutical Co. Ltd
CollaboratorINDUSTRY
Bristol-Myers Squibb
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Histologically confirmed advanced hepatocellular carcinoma, not eligible for surgical and/or locoregional therapies; or progressive disease after surgical and /or locoregional therapies * Locoregional therapy for hepatocellular carcinoma (HCC) must be completed at least 4 weeks prior to the baseline scan * Child-Pugh Class A * Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1

Exclusion criteria

* Known fibrolamellar HCC, sarcomatoid HCC, or mixed cholangiocarcinoma and HCC * Prior liver transplant * Active, known, or suspected autoimmune disease Other protocol-defined inclusion/

Design outcomes

Primary

MeasureTime frameDescription
Overall Survival (OS)time from the date of randomization to the date of death due to any cause, assessed up to June 2019 (approximately 41 months)OS is defined as the time from the date of randomization to the date of death due to any cause in all randomized participants. Participants who are alive will be censored at the last known alive dates. Based on Kaplan-Meier Estimates.

Secondary

MeasureTime frameDescription
Objective Response Rate (ORR) Per BICR RECIST 1.1the date of randomization and the date of first objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first, assessed up to May 2019 (approximately 40 months)ORR is defined as the proportion of participants whose best overall response (BOR) is either a complete response (CR) or partial response (PR). BOR is defined as the best response designation, as determined based on BICR-assessed tumor response according to RECIST 1.1, recorded between the date of randomization and the date of first objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first. For participants without documented progression or subsequent anti-cancer therapy, all available response designations will contribute to the BOR determination. For a BOR of CR or PR, the initial response assessment must be confirmed by a consecutive assessment no less than 4 weeks (28 days) later. Estimate of (Nivolumab - Sorafenib) is based on CMH method of weighting, stratified by stratification factors
Progression-Free Survival (PFS)time from the date of randomization to the date of the first objectively documented tumor progression or death, assessed up to May 2019 (approximately 40 months)PFS is defined as the time from the date of randomization to the date of the first objectively documented tumor progression as assessed by BICR according to RECIST 1.1 or death due to any cause in all randomized participants. Participants who die without a reported prior progression and without initiation of subsequent anti-cancer therapy will be considered to have progressed on the date of their death. Participants who did not progress or die will be censored on the date of their last tumor assessment. Participants who did not have baseline tumor assessment will be censored on the date they were randomized. Participants who did not have any on study tumor assessments and did not die will be censored on the date they were randomized. Participants who started any subsequent anti-cancer therapy without a prior reported progression will be censored at the last tumor assessment prior to subsequent anti-cancer therapy.
Efficacy Based on PD-L1 Expression - OS and PFSthe date of randomization and the date of first objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first, assessed up to May 2019 (approximately 40 months)PD-L1 expression is defined as the percent of tumor cell membrane staining in a minimum of 100 evaluable tumor cells per Dako PD-L1 IHC assay unless otherwise specified. This is referred as quantifiable PD-L1 expression. If the PD-L1 staining could not be quantified, it is further classifies as: Indeterminate: Tumor cell membrane staining hampered for reasons attributed to the biology of the tumor biopsy specimen and not because of improper sample preparation or handling. Not evaluable: Tumor biopsy specimen was not optimally collected or prepared (e.g. PD-L1 expression is neither quantifiable nor indeterminate). PD-L1 status is a dichotomized variable using an X% cut-off for quantifiable PD-L1 expression: * PD-L1 \> X %: ≥ X % PD-L1 expression * PD-L1 \< X %: \< X % PD-L1 expression where X% denotes the PD-L1 expression cut-off of 1%. Additional cut off values may also be explored. Confidence interval based on the Clopper and Pearson method.
Efficacy Based on PD-L1 Expression - ORRthe date of randomization and the date of first objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first, assessed up to May 2019 (approximately 40 months)PD-L1 expression is defined as the percent of tumor cell membrane staining in a minimum of 100 evaluable tumor cells per Dako PD-L1 IHC assay unless otherwise specified. This is referred as quantifiable PD-L1 expression. If the PD-L1 staining could not be quantified, it is further classifies as: Indeterminate: Tumor cell membrane staining hampered for reasons attributed to the biology of the tumor biopsy specimen and not because of improper sample preparation or handling. Not evaluable: Tumor biopsy specimen was not optimally collected or prepared (e.g. PD-L1 expression is neither quantifiable nor indeterminate). PD-L1 status is a dichotomized variable using an X% cut-off for quantifiable PD-L1 expression: * PD-L1 \> X %: ≥ X % PD-L1 expression * PD-L1 \< X %: \< X % PD-L1 expression where X% denotes the PD-L1 expression cut-off of 1%. Additional cut off values may also be explored. Confidence interval based on the Clopper and Pearson method.

Countries

Australia, Austria, Belgium, Canada, China, Czechia, France, Germany, Hong Kong, Israel, Italy, Japan, Poland, Russia, Singapore, South Korea, Spain, Sweden, Switzerland, Taiwan, United Kingdom, United States

Participant flow

Participants by arm

ArmCount
Nivolumab 240 mg
Nivolumab 240 mg intravenously (IV) every 2 weeks until disease progression or unacceptable toxicity
371
Sorafenib 400 mg
Sorafenib 400 mg orally (PO) twice a day (BID) until disease progression or unacceptable toxicity
372
Total743

Withdrawals & dropouts

PeriodReasonFG000FG001
Pre-Treatment PeriodParticipant no longer meets criteria32
Pre-Treatment PeriodParticipant request to stop therapy02
Pre-Treatment PeriodParticipant withdrew consent15
Treatment PeriodAdministrative reason by sponsor01
Treatment PeriodAdverse event unrelated to study drug3941
Treatment PeriodDeath11
Treatment PeriodDisease progression263244
Treatment PeriodLost to Follow-up01
Treatment PeriodMaximum clinical benefit10
Treatment PeriodNOT REPORTED10
Treatment PeriodOther reason128
Treatment PeriodParticipant no longer meets criteria10
Treatment PeriodParticipant request to stop treatment818
Treatment PeriodParticipant withdrew consent37
Treatment PeriodPoor/non-compliance11
Treatment PeriodStudy drug toxicity3741

Baseline characteristics

CharacteristicNivolumab 240 mgSorafenib 400 mgTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
186 Participants196 Participants382 Participants
Age, Categorical
Between 18 and 65 years
185 Participants176 Participants361 Participants
Age, Continuous63.9 years
STANDARD_DEVIATION 10.61
64.5 years
STANDARD_DEVIATION 10.91
64.2 years
STANDARD_DEVIATION 10.76
Ethnicity (NIH/OMB)
Hispanic or Latino
5 Participants10 Participants15 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
180 Participants170 Participants350 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
186 Participants192 Participants378 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants1 Participants1 Participants
Race (NIH/OMB)
Asian
165 Participants167 Participants332 Participants
Race (NIH/OMB)
Black or African American
3 Participants2 Participants5 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
4 Participants6 Participants10 Participants
Race (NIH/OMB)
White
199 Participants196 Participants395 Participants
Sex: Female, Male
Female
57 Participants55 Participants112 Participants
Sex: Female, Male
Male
314 Participants317 Participants631 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
321 / 371335 / 372
other
Total, other adverse events
339 / 367351 / 363
serious
Total, serious adverse events
216 / 367216 / 363

Outcome results

Primary

Overall Survival (OS)

OS is defined as the time from the date of randomization to the date of death due to any cause in all randomized participants. Participants who are alive will be censored at the last known alive dates. Based on Kaplan-Meier Estimates.

Time frame: time from the date of randomization to the date of death due to any cause, assessed up to June 2019 (approximately 41 months)

Population: all randomized participants

ArmMeasureValue (MEDIAN)
Nivolumab 240 mgOverall Survival (OS)16.39 Months
Sorafenib 400 mgOverall Survival (OS)14.69 Months
p-value: 0.075295% CI: [0.71, 1.02]Log Rank
Secondary

Efficacy Based on PD-L1 Expression - ORR

PD-L1 expression is defined as the percent of tumor cell membrane staining in a minimum of 100 evaluable tumor cells per Dako PD-L1 IHC assay unless otherwise specified. This is referred as quantifiable PD-L1 expression. If the PD-L1 staining could not be quantified, it is further classifies as: Indeterminate: Tumor cell membrane staining hampered for reasons attributed to the biology of the tumor biopsy specimen and not because of improper sample preparation or handling. Not evaluable: Tumor biopsy specimen was not optimally collected or prepared (e.g. PD-L1 expression is neither quantifiable nor indeterminate). PD-L1 status is a dichotomized variable using an X% cut-off for quantifiable PD-L1 expression: * PD-L1 \> X %: ≥ X % PD-L1 expression * PD-L1 \< X %: \< X % PD-L1 expression where X% denotes the PD-L1 expression cut-off of 1%. Additional cut off values may also be explored. Confidence interval based on the Clopper and Pearson method.

Time frame: the date of randomization and the date of first objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first, assessed up to May 2019 (approximately 40 months)

Population: all randomized participants with a \>=1% PD-L1 expression all randomized participants with a \<1% PD-L1 expression all randomized participants without PD-L1 quantifiable Note: odds ratio for participants without PD-L1 quantifiable cannot be estimated based on the data

ArmMeasureGroupValue (NUMBER)
Nivolumab 240 mgEfficacy Based on PD-L1 Expression - ORR>=1%, ORR28.2 Percentage of participants
Nivolumab 240 mgEfficacy Based on PD-L1 Expression - ORR<1%, ORR12.2 Percentage of participants
Nivolumab 240 mgEfficacy Based on PD-L1 Expression - ORRwithout PD-L1 quantifiable, ORR20.0 Percentage of participants
Sorafenib 400 mgEfficacy Based on PD-L1 Expression - ORR>=1%, ORR9.4 Percentage of participants
Sorafenib 400 mgEfficacy Based on PD-L1 Expression - ORR<1%, ORR6.7 Percentage of participants
Sorafenib 400 mgEfficacy Based on PD-L1 Expression - ORRwithout PD-L1 quantifiable, ORR0.0 Percentage of participants
95% CI: [1.41, 10.17]
95% CI: [1.1, 3.45]
Secondary

Efficacy Based on PD-L1 Expression - OS and PFS

PD-L1 expression is defined as the percent of tumor cell membrane staining in a minimum of 100 evaluable tumor cells per Dako PD-L1 IHC assay unless otherwise specified. This is referred as quantifiable PD-L1 expression. If the PD-L1 staining could not be quantified, it is further classifies as: Indeterminate: Tumor cell membrane staining hampered for reasons attributed to the biology of the tumor biopsy specimen and not because of improper sample preparation or handling. Not evaluable: Tumor biopsy specimen was not optimally collected or prepared (e.g. PD-L1 expression is neither quantifiable nor indeterminate). PD-L1 status is a dichotomized variable using an X% cut-off for quantifiable PD-L1 expression: * PD-L1 \> X %: ≥ X % PD-L1 expression * PD-L1 \< X %: \< X % PD-L1 expression where X% denotes the PD-L1 expression cut-off of 1%. Additional cut off values may also be explored. Confidence interval based on the Clopper and Pearson method.

Time frame: the date of randomization and the date of first objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first, assessed up to May 2019 (approximately 40 months)

Population: all randomized participants with a \>=1% PD-L1 expression all randomized participants with a \<1% PD-L1 expression all randomized participants without PD-L1 quantifiable

ArmMeasureGroupValue (MEDIAN)
Nivolumab 240 mgEfficacy Based on PD-L1 Expression - OS and PFS>=1%, OS16.07 Months
Nivolumab 240 mgEfficacy Based on PD-L1 Expression - OS and PFS>=1%, PFS3.84 Months
Nivolumab 240 mgEfficacy Based on PD-L1 Expression - OS and PFS<1%, OS16.72 Months
Nivolumab 240 mgEfficacy Based on PD-L1 Expression - OS and PFS<1%, PFS3.61 Months
Nivolumab 240 mgEfficacy Based on PD-L1 Expression - OS and PFSwithout PD-L1 quantifiable, OS16.23 Months
Nivolumab 240 mgEfficacy Based on PD-L1 Expression - OS and PFSwithout PD-L1 quantifiable, PFS2.00 Months
Sorafenib 400 mgEfficacy Based on PD-L1 Expression - OS and PFSwithout PD-L1 quantifiable, OS22.05 Months
Sorafenib 400 mgEfficacy Based on PD-L1 Expression - OS and PFS>=1%, OS8.62 Months
Sorafenib 400 mgEfficacy Based on PD-L1 Expression - OS and PFS<1%, PFS3.75 Months
Sorafenib 400 mgEfficacy Based on PD-L1 Expression - OS and PFS>=1%, PFS3.58 Months
Sorafenib 400 mgEfficacy Based on PD-L1 Expression - OS and PFSwithout PD-L1 quantifiable, PFS6.13 Months
Sorafenib 400 mgEfficacy Based on PD-L1 Expression - OS and PFS<1%, OS15.24 Months
95% CI: [0.54, 1.19]
95% CI: [0.48, 1.03]
95% CI: [0.69, 1.02]
95% CI: [0.81, 1.17]
95% CI: [0.34, 4.74]
95% CI: [0.27, 3.52]
Secondary

Objective Response Rate (ORR) Per BICR RECIST 1.1

ORR is defined as the proportion of participants whose best overall response (BOR) is either a complete response (CR) or partial response (PR). BOR is defined as the best response designation, as determined based on BICR-assessed tumor response according to RECIST 1.1, recorded between the date of randomization and the date of first objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first. For participants without documented progression or subsequent anti-cancer therapy, all available response designations will contribute to the BOR determination. For a BOR of CR or PR, the initial response assessment must be confirmed by a consecutive assessment no less than 4 weeks (28 days) later. Estimate of (Nivolumab - Sorafenib) is based on CMH method of weighting, stratified by stratification factors

Time frame: the date of randomization and the date of first objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first, assessed up to May 2019 (approximately 40 months)

Population: all randomized participants

ArmMeasureValue (NUMBER)
Nivolumab 240 mgObjective Response Rate (ORR) Per BICR RECIST 1.115.4 Percentage of participants
Sorafenib 400 mgObjective Response Rate (ORR) Per BICR RECIST 1.17.0 Percentage of participants
95% CI: [3.9, 12.7]
95% CI: [1.48, 3.92]
Secondary

Progression-Free Survival (PFS)

PFS is defined as the time from the date of randomization to the date of the first objectively documented tumor progression as assessed by BICR according to RECIST 1.1 or death due to any cause in all randomized participants. Participants who die without a reported prior progression and without initiation of subsequent anti-cancer therapy will be considered to have progressed on the date of their death. Participants who did not progress or die will be censored on the date of their last tumor assessment. Participants who did not have baseline tumor assessment will be censored on the date they were randomized. Participants who did not have any on study tumor assessments and did not die will be censored on the date they were randomized. Participants who started any subsequent anti-cancer therapy without a prior reported progression will be censored at the last tumor assessment prior to subsequent anti-cancer therapy.

Time frame: time from the date of randomization to the date of the first objectively documented tumor progression or death, assessed up to May 2019 (approximately 40 months)

Population: all randomized participants

ArmMeasureValue (MEDIAN)
Nivolumab 240 mgProgression-Free Survival (PFS)3.68 Months
Sorafenib 400 mgProgression-Free Survival (PFS)3.75 Months
95% CI: [0.79, 1.1]

Source: ClinicalTrials.gov · Data processed: Mar 1, 2026