Hepatocellular Carcinoma
Conditions
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
Specified Dose on Specified Days
Specified Dose on Specified Days
Sponsors
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| 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
| Measure | Time frame | Description |
|---|---|---|
| Objective Response Rate (ORR) Per BICR RECIST 1.1 | 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) | 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 PFS | 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) | 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 - ORR | 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) | 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
| Arm | Count |
|---|---|
| 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 |
| Total | 743 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Pre-Treatment Period | Participant no longer meets criteria | 3 | 2 |
| Pre-Treatment Period | Participant request to stop therapy | 0 | 2 |
| Pre-Treatment Period | Participant withdrew consent | 1 | 5 |
| Treatment Period | Administrative reason by sponsor | 0 | 1 |
| Treatment Period | Adverse event unrelated to study drug | 39 | 41 |
| Treatment Period | Death | 1 | 1 |
| Treatment Period | Disease progression | 263 | 244 |
| Treatment Period | Lost to Follow-up | 0 | 1 |
| Treatment Period | Maximum clinical benefit | 1 | 0 |
| Treatment Period | NOT REPORTED | 1 | 0 |
| Treatment Period | Other reason | 12 | 8 |
| Treatment Period | Participant no longer meets criteria | 1 | 0 |
| Treatment Period | Participant request to stop treatment | 8 | 18 |
| Treatment Period | Participant withdrew consent | 3 | 7 |
| Treatment Period | Poor/non-compliance | 1 | 1 |
| Treatment Period | Study drug toxicity | 37 | 41 |
Baseline characteristics
| Characteristic | Nivolumab 240 mg | Sorafenib 400 mg | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 186 Participants | 196 Participants | 382 Participants |
| Age, Categorical Between 18 and 65 years | 185 Participants | 176 Participants | 361 Participants |
| Age, Continuous | 63.9 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 Participants | 10 Participants | 15 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 180 Participants | 170 Participants | 350 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 186 Participants | 192 Participants | 378 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 165 Participants | 167 Participants | 332 Participants |
| Race (NIH/OMB) Black or African American | 3 Participants | 2 Participants | 5 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 4 Participants | 6 Participants | 10 Participants |
| Race (NIH/OMB) White | 199 Participants | 196 Participants | 395 Participants |
| Sex: Female, Male Female | 57 Participants | 55 Participants | 112 Participants |
| Sex: Female, Male Male | 314 Participants | 317 Participants | 631 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 321 / 371 | 335 / 372 |
| other Total, other adverse events | 339 / 367 | 351 / 363 |
| serious Total, serious adverse events | 216 / 367 | 216 / 363 |
Outcome results
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
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nivolumab 240 mg | Overall Survival (OS) | 16.39 Months |
| Sorafenib 400 mg | Overall Survival (OS) | 14.69 Months |
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
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Nivolumab 240 mg | Efficacy Based on PD-L1 Expression - ORR | >=1%, ORR | 28.2 Percentage of participants |
| Nivolumab 240 mg | Efficacy Based on PD-L1 Expression - ORR | <1%, ORR | 12.2 Percentage of participants |
| Nivolumab 240 mg | Efficacy Based on PD-L1 Expression - ORR | without PD-L1 quantifiable, ORR | 20.0 Percentage of participants |
| Sorafenib 400 mg | Efficacy Based on PD-L1 Expression - ORR | >=1%, ORR | 9.4 Percentage of participants |
| Sorafenib 400 mg | Efficacy Based on PD-L1 Expression - ORR | <1%, ORR | 6.7 Percentage of participants |
| Sorafenib 400 mg | Efficacy Based on PD-L1 Expression - ORR | without PD-L1 quantifiable, ORR | 0.0 Percentage of participants |
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
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Nivolumab 240 mg | Efficacy Based on PD-L1 Expression - OS and PFS | >=1%, OS | 16.07 Months |
| Nivolumab 240 mg | Efficacy Based on PD-L1 Expression - OS and PFS | >=1%, PFS | 3.84 Months |
| Nivolumab 240 mg | Efficacy Based on PD-L1 Expression - OS and PFS | <1%, OS | 16.72 Months |
| Nivolumab 240 mg | Efficacy Based on PD-L1 Expression - OS and PFS | <1%, PFS | 3.61 Months |
| Nivolumab 240 mg | Efficacy Based on PD-L1 Expression - OS and PFS | without PD-L1 quantifiable, OS | 16.23 Months |
| Nivolumab 240 mg | Efficacy Based on PD-L1 Expression - OS and PFS | without PD-L1 quantifiable, PFS | 2.00 Months |
| Sorafenib 400 mg | Efficacy Based on PD-L1 Expression - OS and PFS | without PD-L1 quantifiable, OS | 22.05 Months |
| Sorafenib 400 mg | Efficacy Based on PD-L1 Expression - OS and PFS | >=1%, OS | 8.62 Months |
| Sorafenib 400 mg | Efficacy Based on PD-L1 Expression - OS and PFS | <1%, PFS | 3.75 Months |
| Sorafenib 400 mg | Efficacy Based on PD-L1 Expression - OS and PFS | >=1%, PFS | 3.58 Months |
| Sorafenib 400 mg | Efficacy Based on PD-L1 Expression - OS and PFS | without PD-L1 quantifiable, PFS | 6.13 Months |
| Sorafenib 400 mg | Efficacy Based on PD-L1 Expression - OS and PFS | <1%, OS | 15.24 Months |
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
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Nivolumab 240 mg | Objective Response Rate (ORR) Per BICR RECIST 1.1 | 15.4 Percentage of participants |
| Sorafenib 400 mg | Objective Response Rate (ORR) Per BICR RECIST 1.1 | 7.0 Percentage of participants |
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
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Nivolumab 240 mg | Progression-Free Survival (PFS) | 3.68 Months |
| Sorafenib 400 mg | Progression-Free Survival (PFS) | 3.75 Months |