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A Study to Evaluate Efficacy in Subjects With Esophageal Cancer Treated With Nivolumab and Ipilimumab or Nivolumab Combined With Fluorouracil Plus Cisplatin Versus Fluorouracil Plus Cisplatin

A Randomized Phase 3 Study of Nivolumab Plus Ipilimumab or Nivolumab Combined With Fluorouracil Plus Cisplatin Versus Fluorouracil Plus Cisplatin in Subjects With Unresectable Advanced, Recurrent or Metastatic Previously Untreated Esophageal Squamous Cell Carcinoma

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03143153
Acronym
CheckMate 648
Enrollment
970
Registered
2017-05-08
Start date
2017-06-29
Completion date
2025-01-13
Last updated
2026-02-17

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

Conditions

Various Advanced Cancer

Brief summary

The main purpose of this study is to compare how long subjects with esophageal cancer live overall or live without disease progression after receiving nivolumab and ipilimumab or nivolumab combined with fluorouracil plus cisplatin versus fluorouracil plus cisplatin

Interventions

BIOLOGICALNivolumab

Specified dose on specified days

BIOLOGICALIpilimumab

Specified dose on specified days

DRUGCisplatin

Specified dose on specified days

DRUGFluorouracil

Specified dose on specified days

Sponsors

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

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

* Must have histologically confirmed squamous cell carcinoma or adenosquamous cell carcinoma of esophagus * Male or Female at least 18 years of age * Must have esophageal cancer that cannot be operated on, or treated with definitive chemoradiation with curative intent, that is advanced, reoccurring or has spread out * Must have full activity or, if limited, must be able to walk and carry out light activities such as light house work or office work * Must agree to provide tumor tissue sample, either from a previous surgery or biopsy within 6 months or fresh, prior to the start of treatment in this study

Exclusion criteria

* Presence of tumor cells in the brain or spinal cord which are symptomatic or require treatment * Active known or suspected autoimmune disease * Any serious or uncontrolled medical disorder or active infection * Known history of positive test for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS) * Any positive test result for hepatitis B or C indicating acute or chronic infection and/or detectable virus Other protocol defined inclusion/

Design outcomes

Primary

MeasureTime frameDescription
Overall Survival (OS) in Participants With Tumor Cell PD-L1From the date of randomization to up to the date of death (up to approximately 20 months)Overall Survival (OS) is defined as the time between the date of randomization and the date of death. For participants without documentation of death, OS will be censored on the last date the subject was known to be alive.
Progression-free Survival (PFS) as Assessed by BICR in Participants With Tumor Cell PD-L1From the date of randomization to up to the date of the first documented disease progression or death (up to approximately 9 months)Progression-free survival (PFS) is defined as the time from randomization to the date of the first documented progressive disease (PD) per Blinded Independent Central Review (BICR) or death due to any cause. Participants who die without a reported prior PD per BICR (and die without start of subsequent therapy) will be considered to have progressed on the date of death. Participants who did not have documented PD per BICR per RECIST1.1 criteria and who did not die, will be censored at the date of the last evaluable tumor assessment on or prior to initiation of the subsequent anti-cancer therapy. Participants who did not have any on-study tumor assessments and did not die (or died after initiation of the subsequent anti-cancer therapy) will be censored at the randomization date. Participants who started any subsequent anti-cancer therapy without a prior reported PD per BICR will be censored at the last tumor assessment on or prior to initiation of the subsequent anti-cancer therapy.

Secondary

MeasureTime frameDescription
Overall Survival (OS) in All Randomized ParticipantsFrom the date of randomization to up to the date of death (up to approximately 88 months)Overall Survival (OS) is defined as the time between the date of randomization and the date of death. For participants without documentation of death, OS will be censored on the last date the subject was known to be alive.
Progression-free Survival (PFS) in All Randomized Participants as Assessed by BICRFrom the date of randomization to up to the date of the first documented disease progression or death (up to approximately 88 months)Progression-free survival (PFS) is defined as the time from randomization to the date of the first documented progressive disease (PD) per Blinded Independent Central Review (BICR) or death due to any cause. Participants who die without a reported prior PD per BICR (and die without start of subsequent therapy) will be considered to have progressed on the date of death. Participants who did not have documented PD per BICR per RECIST1.1 criteria and who did not die, will be censored at the date of the last evaluable tumor assessment on or prior to initiation of the subsequent anti-cancer therapy. Participants who did not have any on-study tumor assessments and did not die (or died after initiation of the subsequent anti-cancer therapy) will be censored at the randomization date. Participants who started any subsequent anti-cancer therapy without a prior reported PD per BICR will be censored at the last tumor assessment on or prior to initiation of the subsequent anti-cancer therapy.
Objective Response Rate (ORR) as Assessed by BICRFrom the date of randomization to up to the date of objectively documented progression or the date of subsequent anti-cancer therapy, whichever occurs first (up to 88 months)Objective response rate (ORR) is defined as the percentage of participants with a best overall response (BOR) of complete response (CR) or partial response (PR). Best overall response (BOR) is defined as the best response designation as determined by BICR, recorded between the date of randomization and the date of objectively documented progression (per RECIST 1.1) or the date of subsequent anti-cancer therapy (including tumor-directed radiotherapy and tumor-directed surgery), whichever occurs first. Partial response is defined as at least a 30% decrease in the sum of diameters of target lesions. Complete response is defined as the disappearance of all target lesions and the reduction of any pathological lymph nodes to \<10 mm.

Countries

Argentina, Australia, Austria, Brazil, Canada, Chile, China, Colombia, Czechia, Denmark, France, Hong Kong, Italy, Japan, Mexico, Peru, Poland, Portugal, Romania, Russia, Singapore, South Korea, Spain, Taiwan, Turkey (Türkiye), United Kingdom, United States

Contacts

STUDY_DIRECTORBristol-Myers Squibb

Bristol-Myers Squibb

Participant flow

Pre-assignment details

970 participants randomized, 936 treated.

Participants by arm

ArmCount
Arm A: Nivolumab + Ipilimumab
Participants will receive treatment with nivolumab 3 mg/kg as a 30-minute infusion every 2 weeks and ipilimumab as a 30-minute infusion 1 mg/kg every 6 weeks.
325
Arm B: Nivolumab + Chemotherapy
Participants will receive treatment with nivolumab 240 mg as a 30-minute infusion on Day 1 and Day 15, fluorouracil 800 mg/m²/day as an IV continuous infusion on Day 1 through Day 5 (for 5 days), and cisplatin 80 mg/m² as a 30- to 120-minute infusion on Day 1 of 4-week cycle.
321
Arm C: Chemotherapy
Participants will receive treatment with fluorouracil 800 mg/m²/day as an IV continuous infusion from Day 1 through Day 5 (for 5 days), and cisplatin 80 mg/m² as a 30- to 120-minute infusion on Day 1 of 4-week cycle.
324
Total970

Baseline characteristics

CharacteristicArm A: Nivolumab + IpilimumabArm B: Nivolumab + ChemotherapyArm C: ChemotherapyTotal
Age, Continuous62.2 Years
STANDARD_DEVIATION 9.1
63.1 Years
STANDARD_DEVIATION 9.2
63.3 Years
STANDARD_DEVIATION 8.7
62.9 Years
STANDARD_DEVIATION 9
Race/Ethnicity, Customized
American Indian or Alaska Native
1 Participants2 Participants1 Participants4 Participants
Race/Ethnicity, Customized
Asian Indian
1 Participants4 Participants3 Participants8 Participants
Race/Ethnicity, Customized
Asian Other
28 Participants23 Participants17 Participants68 Participants
Race/Ethnicity, Customized
Black or African American
4 Participants1 Participants6 Participants11 Participants
Race/Ethnicity, Customized
Chinese
71 Participants74 Participants70 Participants215 Participants
Race/Ethnicity, Customized
Japanese
131 Participants126 Participants137 Participants394 Participants
Race/Ethnicity, Customized
Other
10 Participants6 Participants6 Participants22 Participants
Race/Ethnicity, Customized
White
79 Participants85 Participants84 Participants248 Participants
Sex: Female, Male
Female
56 Participants68 Participants49 Participants173 Participants
Sex: Female, Male
Male
269 Participants253 Participants275 Participants797 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
270 / 325273 / 321286 / 324
other
Total, other adverse events
301 / 322307 / 310288 / 304
serious
Total, serious adverse events
243 / 322226 / 310174 / 304

Outcome results

Primary

Overall Survival (OS) in Participants With Tumor Cell PD-L1

Overall Survival (OS) is defined as the time between the date of randomization and the date of death. For participants without documentation of death, OS will be censored on the last date the subject was known to be alive.

Time frame: From the date of randomization to up to the date of death (up to approximately 20 months)

Population: All randomized PD-L1 expressing participants

ArmMeasureValue (MEDIAN)
Arm A: Nivolumab + IpilimumabOverall Survival (OS) in Participants With Tumor Cell PD-L113.70 Months
Arm B: Nivolumab + ChemotherapyOverall Survival (OS) in Participants With Tumor Cell PD-L115.44 Months
Arm C: ChemotherapyOverall Survival (OS) in Participants With Tumor Cell PD-L19.07 Months
Comparison: Hazard Ratio is Arm A: Nivolumab + Ipilimumab over Arm C: Chemotherapy.p-value: 0.00198.6% CI: [0.46, 0.9]Log Rank
Comparison: Hazard Ratio is Arm A: Nivolumab + Ipilimumab over Arm C: Chemotherapy.p-value: 0.00195% CI: [0.49, 0.84]Log Rank
Comparison: Hazard Ratio is Arm B: Nivolumab + Chemotherapy over Arm C: Chemotherapyp-value: <0.000199.5% CI: [0.37, 0.8]Log Rank
Comparison: Hazard Ratio is Arm B: Nivolumab + Chemotherapy over Arm C: Chemotherapyp-value: <0.000195% CI: [0.41, 0.71]Log Rank
Primary

Progression-free Survival (PFS) as Assessed by BICR in Participants With Tumor Cell PD-L1

Progression-free survival (PFS) is defined as the time from randomization to the date of the first documented progressive disease (PD) per Blinded Independent Central Review (BICR) or death due to any cause. Participants who die without a reported prior PD per BICR (and die without start of subsequent therapy) will be considered to have progressed on the date of death. Participants who did not have documented PD per BICR per RECIST1.1 criteria and who did not die, will be censored at the date of the last evaluable tumor assessment on or prior to initiation of the subsequent anti-cancer therapy. Participants who did not have any on-study tumor assessments and did not die (or died after initiation of the subsequent anti-cancer therapy) will be censored at the randomization date. Participants who started any subsequent anti-cancer therapy without a prior reported PD per BICR will be censored at the last tumor assessment on or prior to initiation of the subsequent anti-cancer therapy.

Time frame: From the date of randomization to up to the date of the first documented disease progression or death (up to approximately 9 months)

Population: All randomized PD-L1 expressing participants

ArmMeasureValue (MEDIAN)
Arm A: Nivolumab + IpilimumabProgression-free Survival (PFS) as Assessed by BICR in Participants With Tumor Cell PD-L14.04 Months
Arm B: Nivolumab + ChemotherapyProgression-free Survival (PFS) as Assessed by BICR in Participants With Tumor Cell PD-L16.93 Months
Arm C: ChemotherapyProgression-free Survival (PFS) as Assessed by BICR in Participants With Tumor Cell PD-L14.44 Months
Comparison: Hazard Ratio is Arm A: Nivolumab + Ipilimumab over Arm C: Chemotherapyp-value: 0.895898.5% CI: [0.73, 1.43]Log Rank
Comparison: Hazard Ratio is Arm A: Nivolumab + Ipilimumab over Arm C: Chemotherapyp-value: 0.895895% CI: [0.78, 1.34]Log Rank
Comparison: Hazard Ratio is Arm B: Nivolumab + Chemotherapy over Arm C: Chemotherapyp-value: 0.002398.5% CI: [0.46, 0.92]Log Rank
Comparison: Hazard Ratio is Arm B: Nivolumab + Chemotherapy over Arm C: Chemotherapyp-value: 0.002395% CI: [0.49, 0.86]Log Rank
Secondary

Objective Response Rate (ORR) as Assessed by BICR

Objective response rate (ORR) is defined as the percentage of participants with a best overall response (BOR) of complete response (CR) or partial response (PR). Best overall response (BOR) is defined as the best response designation as determined by BICR, recorded between the date of randomization and the date of objectively documented progression (per RECIST 1.1) or the date of subsequent anti-cancer therapy (including tumor-directed radiotherapy and tumor-directed surgery), whichever occurs first. Partial response is defined as at least a 30% decrease in the sum of diameters of target lesions. Complete response is defined as the disappearance of all target lesions and the reduction of any pathological lymph nodes to \<10 mm.

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

Population: All randomized PD-L1 expressing participants and all randomized participants

ArmMeasureGroupValue (NUMBER)
Arm A: Nivolumab + IpilimumabObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status >= 10%36.9 Percentage of participants
Arm A: Nivolumab + IpilimumabObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status < 5%22.3 Percentage of participants
Arm A: Nivolumab + IpilimumabObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status indeterminate, not evaluable, or missing33.3 Percentage of participants
Arm A: Nivolumab + IpilimumabObjective Response Rate (ORR) as Assessed by BICRAll randomized participants27.7 Percentage of participants
Arm A: Nivolumab + IpilimumabObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status < 1%20.1 Percentage of participants
Arm A: Nivolumab + IpilimumabObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status >= 1%35.4 Percentage of participants
Arm A: Nivolumab + IpilimumabObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status >= 5%36.7 Percentage of participants
Arm A: Nivolumab + IpilimumabObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status < 10%23.3 Percentage of participants
Arm B: Nivolumab + ChemotherapyObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status >= 10%50.0 Percentage of participants
Arm B: Nivolumab + ChemotherapyObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status < 1%41.7 Percentage of participants
Arm B: Nivolumab + ChemotherapyObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status < 10%46.1 Percentage of participants
Arm B: Nivolumab + ChemotherapyObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status < 5%44.8 Percentage of participants
Arm B: Nivolumab + ChemotherapyObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status >= 5%51.7 Percentage of participants
Arm B: Nivolumab + ChemotherapyObjective Response Rate (ORR) as Assessed by BICRAll randomized participants47.4 Percentage of participants
Arm B: Nivolumab + ChemotherapyObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status >= 1%53.2 Percentage of participants
Arm C: ChemotherapyObjective Response Rate (ORR) as Assessed by BICRAll randomized participants26.9 Percentage of participants
Arm C: ChemotherapyObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status < 1%33.7 Percentage of participants
Arm C: ChemotherapyObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status >= 1%19.9 Percentage of participants
Arm C: ChemotherapyObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status < 5%30.9 Percentage of participants
Arm C: ChemotherapyObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status >= 5%20.0 Percentage of participants
Arm C: ChemotherapyObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status < 10%29.3 Percentage of participants
Arm C: ChemotherapyObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status >= 10%21.6 Percentage of participants
Arm C: ChemotherapyObjective Response Rate (ORR) as Assessed by BICRParticipants with baseline PD-L1 status indeterminate, not evaluable, or missing0.0 Percentage of participants
Secondary

Overall Survival (OS) in All Randomized Participants

Overall Survival (OS) is defined as the time between the date of randomization and the date of death. For participants without documentation of death, OS will be censored on the last date the subject was known to be alive.

Time frame: From the date of randomization to up to the date of death (up to approximately 16 months)

Population: All randomized participants

ArmMeasureValue (MEDIAN)
Arm A: Nivolumab + IpilimumabOverall Survival (OS) in All Randomized Participants12.75 Months
Arm B: Nivolumab + ChemotherapyOverall Survival (OS) in All Randomized Participants13.21 Months
Arm C: ChemotherapyOverall Survival (OS) in All Randomized Participants10.71 Months
Comparison: Hazard Ratio is Arm A: Nivolumab + Ipilimumab over Arm C: Chemotherapyp-value: 0.01195% CI: [0.65, 0.95]Log Rank
Comparison: Hazard Ratio is Arm A: Nivolumab + Ipilimumab over Arm C: Chemotherapyp-value: 0.01198.2% CI: [0.62, 0.98]Log Rank
Comparison: Hazard Ratio is Arm B: Nivolumab + Chemotherapy over Arm C: Chemotherapyp-value: 0.002199.1% CI: [0.58, 0.96]Log Rank
Comparison: Hazard Ratio is Arm B: Nivolumab + Chemotherapy over Arm C: Chemotherapyp-value: 0.002195% CI: [0.61, 0.9]Log Rank
Secondary

Progression-free Survival (PFS) in All Randomized Participants as Assessed by BICR

Progression-free survival (PFS) is defined as the time from randomization to the date of the first documented progressive disease (PD) per Blinded Independent Central Review (BICR) or death due to any cause. Participants who die without a reported prior PD per BICR (and die without start of subsequent therapy) will be considered to have progressed on the date of death. Participants who did not have documented PD per BICR per RECIST1.1 criteria and who did not die, will be censored at the date of the last evaluable tumor assessment on or prior to initiation of the subsequent anti-cancer therapy. Participants who did not have any on-study tumor assessments and did not die (or died after initiation of the subsequent anti-cancer therapy) will be censored at the randomization date. Participants who started any subsequent anti-cancer therapy without a prior reported PD per BICR will be censored at the last tumor assessment on or prior to initiation of the subsequent anti-cancer therapy.

Time frame: From the date of randomization to up to the date of the first documented disease progression or death (up to approximately 7 months)

Population: All randomized participants

ArmMeasureValue (MEDIAN)
Arm A: Nivolumab + IpilimumabProgression-free Survival (PFS) in All Randomized Participants as Assessed by BICR2.92 Months
Arm B: Nivolumab + ChemotherapyProgression-free Survival (PFS) in All Randomized Participants as Assessed by BICR5.82 Months
Arm C: ChemotherapyProgression-free Survival (PFS) in All Randomized Participants as Assessed by BICR5.59 Months
Comparison: Hazard Ratio is Arm B: Nivolumab + Chemotherapy over Arm C: Chemotherapyp-value: 0.035595% CI: [0.67, 0.99]Log Rank
Comparison: Hazard Ratio is Arm A: Nivolumab + Ipilimumab over Arm C: Chemotherapy95% CI: [1.04, 1.52]
Comparison: Hazard Ratio is Arm B: Nivolumab + Chemotherapy over Arm C: Chemotherapyp-value: 0.035598.5% CI: [0.64, 1.04]Log Rank

Source: ClinicalTrials.gov · Data processed: Feb 24, 2026