Hepatocellular Carcinoma (HCC)
Conditions
Keywords
Advanced liver cancer, RATIONALE-301
Brief summary
This Phase 3 study was a global, multicenter trial that randomly assigned participants to either tislelizumab or sorafenib as a first-line treatment for adults with advanced liver cancer (hepatocellular carcinoma) that could not be surgically removed. Before enrolling Japanese participants in the main Phase 3 study, a preliminary assessment of safety and tolerability (the Safety Run-In Sub-study) was conducted in Japan.
Interventions
Tislelizumab 200 mg intravenously (IV) once every three weeks (Q3W)
Sorafenib 400 mg orally (PO) twice daily (BID)
Sponsors
Study design
Eligibility
Inclusion criteria
Safety Run-In Sub-study Eligibility Criteria: The study included adult Japanese participants (≥ 20 years) with histologically confirmed hepatocellular carcinoma (HCC) at Barcelona Clinic Liver Cancer (BCLC) Stage C or B. Eligible participants had either received, were ineligible for, or declined standard treatment. Additional requirements were a Child-Pugh A classification within 7 days before enrollment, at least one measurable lesion per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, and an Eastern Cooperative Oncology Group (ECOG) Performance Status score of ≤ 1. Main Study Key Inclusion Criteria: 1. Histologically confirmed diagnosis of HCC 2. Barcelona Clinic Liver Cancer (BCLC) Stage B or C disease not amenable to or progressing after loco-regional therapy and not amenable to a curative treatment approach 3. No prior systemic therapy for HCC (with the exception of HCC participants enrolled in the safety run-in substudy \[Japan only\]) 4. Measurable disease 5. Child-Pugh score A 6. Easter Cooperative Oncology Group (ECOG) Performance Status ≤ 1 7. Adequate organ function Main Study Key
Exclusion criteria
1. Known fibrolamellar HCC, sarcomatoid HCC, or mixed cholangiocarcinoma and HCC histology 2. Tumor thrombus involving main trunk of portal vein or inferior vena cava 3. Loco-regional therapy to the liver within 28 days before randomization 4. Clinical evidence of portal hypertension with bleeding esophageal or gastric varices at Screening, or within 6 months before randomization 5. Bleeding or thrombotic disorder or any prescribed anticoagulant requiring therapeutic international normalized ratio monitoring (eg, warfarin or similar agents) at Screening, or within 6 months before randomization/enrollment 6. Presence at Screening of active immune deficiency or autoimmune disease and/or prior history of any immune deficiency or autoimmune disease that may relapse 7. Participant with any condition requiring systemic treatment with either corticosteroids (\> 10 mg daily of prednisone or equivalent) or other immunosuppressive medication within 14 days before randomization 8. History of interstitial lung disease or non-infectious pneumonitis, unless induced by radiation therapy 9. QT interval corrected for heart rate (QTc) (corrected by Fridericia's method) \> 450 msec at Screening NOTE: Other protocol defined Inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Safety Run-in Sub-study: Number of Participants With Treatment-emergent Adverse Events (TEAEs) | From the first dose to 30 days after the last dose, new anticancer therapy, or the analysis cutoff of December 14th, 2023 (a maximum of 64 months) | An adverse event (AE) is any unfavorable or unintended sign (e.g., abnormal lab result), symptom, or disease temporally associated with study drug use, regardless of causality. A serious adverse event (SAE) is defined as any adverse event that: * Resulted in death * Was life-threatening * Required or prolonged hospitalization * Caused disability/incapacity * Lead to a congenital anomaly/birth defect * Was deemed medically significant by the investigator (e.g., required intervention to prevent severe outcomes). |
| Safety Run-in Sub-study: Serum Concentration of Tislelizumab | Cycle 1 and Cycle 5 at end of infusion, 24 hand 72 hours post-dose, and 8 days and 15 days post-dose (each cycle was 3 weeks). | Serum concentration of tislelizumab was a pre-specified primary endpoint for the sub-study only. |
| Main Study: Overall Survival (OS) | Through the primary analysis data cut-off date of July 11th, 2022 (up to approximately 55 months) | Defined as the time from the date of randomization to the date of death due to any cause. Median OS was estimated using Kaplan-Meier methodology. Overall survival was a pre-specified primary endpoint for the main study only. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival (PFS) Assessed by the Investigator | Through the study completion data cut-off date of December 14th, 2023 (up to approximately 65 months) | Defined as the time from randomization to the first objectively documented disease progression, or death from any cause, whichever occurred first, as assessed by the investigator per RECIST v1.1. Kaplan-Meier methodology was used to estimate the median PFS. |
| Duration of Response (DOR) as Assessed by BIRC | Through the primary analysis data cut-off date of July 11th, 2022 (up to approximately 55 months) | Defined as the time from the first occurrence of a documented objective response until the first documentation of progression or death from any cause, whichever occurred first, as determined by the BIRC per RECIST v1.1. Median DOR was estimated using Kaplan-Meier methodology. DOR was not assessed by the BIRC for participants in the sub-study, and this was not a pre-specified sub-study endpoint. |
| Duration of Response (DOR) Assessed by the Investigator | Through the study completion data cut-off date of December 14th, 2023 (up to approximately 65 months) | Defined as the time from the first occurrence of a documented objective response until the first documentation of progression or death from any cause, whichever occurred first, as assessed by the investigator per RECIST v1.1. Median DOR was estimated using Kaplan-Meier methodology. |
| Time to Progression (TTP) Assessed by BIRC | Through the primary analysis data cut-off date of July 11th, 2022 (up to approximately 55 months) | Defined as the time from the date of randomization to the date of the first objectively documented tumor progression as assessed by the BIRC per RECIST v1.1. Median TTP was estimated using Kaplan-Meier methodology. TTP was not assessed by the BIRC for participants in the sub-study, and this was not a pre-specified sub-study endpoint. |
| Time to Progression (TTP) as Assessed by the Investigator | Through the study completion data cut-off date of December 14th, 2023 (up to approximately 65 months) | Defined as the time from the date of randomization to the date of the first objectively documented tumor progression as assessed by the investigator per RECIST v1.1. Median TTP was estimated using Kaplan-Meier methodology. TTP was not a pre-specified sub-study endpoint. |
| Safety Run-in Sub-study: Overall Survival | Up a to 64 months | Defined as the time from the date of randomization to the date of death due to any cause. Median OS was estimated using Kaplan-Meier methodology. |
| Disease Control Rate (DCR) as Assessed by BIRC | Through the primary analysis data cut-off date of July 11th, 2022 (up to approximately 55 months) | Defined as the percentage of participants whose best overall response (BOR) was complete response, partial response, or stable disease as assessed by the BIRC per RECIST v1.1. DCR was not a pre-specified endpoint for participants in the sub-study. |
| Disease Control Rate (DCR) as Assessed by the Investigator | Through the study completion data cut-off date of December 14th, 2023 (up to approximately 65 months) | Defined as the percentage of participants whose best overall response (BOR) was complete response, partial response, or stable disease as assessed by the investigator per RECIST v1.1. DCR was not a pre-specified endpoint for participants in the sub-study. |
| Clinical Benefit Rate (CBR) as Assessed by BIRC | Through the primary analysis data cut-off date of July 11th, 2022 (up to approximately 55 months) | Defined as the percentage of participants whose best overall response (BOR) was complete response, partial response, or stable disease greater than or equal to 24 weeks in duration, as assessed by the BIRC per RECIST v1.1. CBR was not a pre-specified endpoint for participants in the sub-study. |
| Overall Response Rate (ORR) as Assessed by Blinded Independent Review Committee (BIRC) | Through the primary analysis data cut-off date of July 11th, 2022 (up to approximately 55 months) | Defined as the percentage of participants who had partial response or complete response as determined by Blinded Independent Review Committee (BIRC) per the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 in all randomized participants with measurable disease at baseline. ORR was not assessed by the BIRC for participants in the sub-study, and this was not a pre-specified sub-study endpoint. |
| Change From Baseline in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Hepatocellular Carcinoma 18 Questions (EORTC QLQ HCC 18) Index Score at Cycle 4 | Baseline to Cycle 4 (each cycle was 21 days) | The EORTC QLQ-HCC18 is a questionnaire specifically designed to assess health-related quality of life in participants with hepatocellular carcinoma. It includes six symptom scales measuring Fatigue (3 items), Jaundice (2 items), Body Image (2 items), Nutrition (5 items), Pain (2 items), Fever (2 items) and two single items measuring Sex Life and Abdominal Swelling. Participants respond on a scale from 1 = Not at all to 4 = Very Much. Raw scores are transformed into a 0 to 100 scale using linear transformation. The HCC18 Index score is calculated from each of the 6 symptom scales and the 2 single items, and ranges from 0 to 100. Higher scores indicate greater symptom burden or worse quality of life. The EORTC QLQ-HCC18 was not assessed for participants in the sub-study. |
| Change From Baseline in the European EORTC QLQ HCC 18 Index Score at Cycle 6 | Baseline to Cycle 6 (Each cycle was 21 days) | The EORTC QLQ-HCC18 is a questionnaire specifically designed to assess health-related quality of life in participants with hepatocellular carcinoma. It includes six symptom scales measuring Fatigue (3 items), Jaundice (2 items), Body Image (2 items), Nutrition (5 items), Pain (2 items), Fever (2 items) and two single items measuring Sex Life and Abdominal Swelling. Participants respond on a scale from 1 = Not at all to 4 = Very Much. Raw scores are transformed into a 0 to 100 scale using linear transformation. The HCC18 Index score is calculated from each of the 6 symptom scales and the 2 single items, and ranges from 0 to 100. Higher scores indicate greater symptom burden or worse quality of life. The HEORTC QLQ-HCC18 was not assessed in participants in the sub-study. |
| Change From Baseline in the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status/Quality of Life Score at Cycle 4 | Baseline to Cycle 4 (each cycle was 21 days) | The EORTC QLQ-C30 v3.0 is a questionnaire that assesses quality of life of participants with cancer. It includes global health status and quality of life questions related to overall health in which participants respond based on a 7-point scale, where 1 is very poor and 7 is excellent. Raw scores are transformed into a 0 to 100 scale via linear transformation. A higher score indicates better health outcomes. The EORTC QLQ-C30 was not assessed in participants in the sub-study. |
| Change From Baseline in the EORTC QLQ-C30 Global Health Status/Quality of Life Score at Cycle 6 | Baseline to Cycle 6 (each cycle was 21 days) | The EORTC QLQ-C30 v3.0 is a questionnaire that assesses quality of life of participants with cancer. It includes global health status and quality of life questions related to overall health in which participants respond based on a 7-point scale, where 1 is very poor and 7 is excellent. Raw scores are transformed into a 0 to 100 scale via linear transformation. A higher score indicates better health outcomes. The EORTC QLQ-C30 was not assessed in participants in the sub-study. |
| Change From Baseline in the European Quality of Life 5 Dimensions, 5-level (EQ-5D-5L) Visual Analogue Scale (VAS) at Cycle 4 | Baseline to Cycle 4 (each cycle was 21 days) | The EQ-5D-5L comprises a descriptive module and a Visual Analogue scale (VAS). The EQ-5D-5L VAS measures respondent's self-rated health status on a 0 to 100 scale, with 100 = 'the best health you can imagine' and 0 = 'the worst health you can imagine'. Higher scores on VAS indicate higher health status. The EQ-5D-5L VAS was not assessed in participants in the sub-study. |
| Change From Baseline in the EQ-5D-5L VAS at Cycle 6 | Baseline to Cycle 6 (each cycle was 21 days) | The EQ-5D-5L comprises a descriptive module and a visual analogue scale (VAS). The EQ-5D-5L VAS measures respondent's self-rated health status on a 0 to 100 scale, with 100 = 'the best health you can imagine' and 0 = 'the worst health you can imagine'. Higher scores on VAS indicate higher health status. The EQ-5D-5L VAS was not assessed in participants in the sub-study. |
| Main Study: Number of Participants With Treatment-emergent Adverse Events | From the first dose to 30 days after the last dose, new anticancer therapy, or the study completion analysis cutoff on December 14th, 2023 (a maximum of 61 months for participants in Arm A and 63 months for participants in Arm B). | An adverse event (AE) is any unfavorable or unintended sign (e.g., abnormal lab result), symptom, or disease temporally associated with study drug use, regardless of causality. A serious adverse event (SAE) is defined as any adverse event that: * Resulted in death * Was life-threatening * Required or prolonged hospitalization * Caused disability/incapacity * Lead to a congenital anomaly/birth defect * Was deemed medically significant by the investigator (e.g., required intervention to prevent severe outcomes). |
| Safety Run-in Sub-study: Number of Participants Who Developed Anti-tislelizumab Antibodies | From the first dose to 30 days after the last dose, new anticancer therapy, or the analysis cutoff of December 14th, 2023 (a maximum of 64 months) | Treatment-emergent anti-drug antibodies (ADA): participants who were ADA negative at baseline and ADA positive post-baseline. Treatment-boosted ADA: participants who were ADA positive at baseline that was boosted to a 4-fold or higher-level following drug administration. ADA assessments were not performed for participants enrolled in the main study. |
| Clinical Benefit Rate (CBR) as Assessed by the Investigator | Through the study completion data cut-off date of December 14th, 2023 (up to approximately 65 months) | Defined as the percentage of participants whose best overall response (BOR) is complete response, partial response, or stable disease greater than or equal to 24 weeks in duration, as assessed by the investigator per RECIST v1.1. CBR was not a pre-specified endpoint for participants in the sub-study. |
| Overall Response Rate (ORR) as Assessed by the Investigator | Through the study completion data cut-off date of December 14th, 2023 (up to approximately 65 months) | Defined as the percentage of participants who had partial response or complete response as determined by the investigator per RECIST v1.1 in all randomized participants with measurable disease at baseline. |
| Progression Free Survival (PFS) as Assessed by BIRC | Through the primary analysis data cut-off date of July 11th, 2022 (up to approximately 55 months) | Defined as the time from randomization to the first objectively documented disease progression, or death from any cause, whichever occurred first, as assessed by the BIRC per RECIST v1.1. Kaplan-Meier methodology was used to estimate the median PFS. PFS was not assessed by the BIRC for participants in the sub-study, and this was not a pre-specified sub-study endpoint. |
Countries
China, Czechia, France, Germany, Italy, Japan, Poland, Spain, Taiwan, United Kingdom, United States
Participant flow
Recruitment details
The main study enrolled participants across centers in Asia, Europe, and the U.S. The first participant consented on December 18, 2017, and the study concluded on December 14, 2023. In Japan, a safety run-in sub-study was conducted to evaluate tislelizumab's safety and tolerability in Japanese patients with hepatocellular carcinoma (HCC). Sub-study participants were not assessed for the same primary and secondary endpoints specified for the main study.
Pre-assignment details
The main study had 4 phases: Screening, Treatment, Safety Follow-up (up to 30 days post-treatment or 90 days post-tislelizumab for immune events); and Survival Follow-up (duration varied). Randomization in the main study was stratified by macrovascular invasion (present vs absent), extrahepatic spread (present vs absent), etiology (hepatitis C virus vs other), Eastern Cooperative Oncology Group Performance Status (0 vs 1) and geography (Asia \[excluding Japan\] vs Japan vs Rest of World).
Participants by arm
| Arm | Count |
|---|---|
| Safety Run-In Sub-study Japanese participants received 200 mg intravenous tislelizumab every 3 weeks to assess preliminary safety and tolerability. | 10 |
| Arm A: Tislelizumab Participants received 200 mg of intravenous tislelizumab every 3 weeks until intolerable toxicity, withdrawal of consent, or the investigator determined no further benefit from the therapy. | 342 |
| Arm B: Sorafenib Participants received 400 mg of oral sorafenib twice daily until intolerable toxicity, consent withdrawal, or the investigator deemed no further benefit. | 332 |
| Total | 684 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Death | 7 | 259 | 273 |
| Overall Study | Lost to Follow-up | 0 | 7 | 6 |
| Overall Study | Physician Decision | 0 | 0 | 1 |
| Overall Study | Study Closed By Sponsor | 3 | 46 | 33 |
| Overall Study | Transfer to Long Term Extension (BGB-A317-290-LTE1) or Post Trial Supply (PTS) | 0 | 15 | 0 |
| Overall Study | Withdrawal by Subject | 0 | 15 | 19 |
Baseline characteristics
| Characteristic | Total | Arm B: Sorafenib | Arm A: Tislelizumab | Safety Run-In Sub-study |
|---|---|---|---|---|
| Age, Continuous | 60.15 years STANDARD_DEVIATION 12.652 | 59.51 years STANDARD_DEVIATION 12.737 | 60.45 years STANDARD_DEVIATION 12.528 | 71.70 years STANDARD_DEVIATION 8.247 |
| Eastern Cooperative Oncology Group (ECOG) Performance Status 0 (Fully active) | 371 Participants | 180 Participants | 182 Participants | 9 Participants |
| Eastern Cooperative Oncology Group (ECOG) Performance Status 1 (Restricted but ambulatory) | 313 Participants | 152 Participants | 160 Participants | 1 Participants |
| Etiology Hepatitis C Virus | 89 Participants | 39 Participants | 46 Participants | 4 Participants |
| Etiology Other | 595 Participants | 293 Participants | 296 Participants | 6 Participants |
| Extrahepatic Spread Absent | 263 Participants | 134 Participants | 123 Participants | 6 Participants |
| Extrahepatic Spread Present | 421 Participants | 198 Participants | 219 Participants | 4 Participants |
| Geographic Region Asia (excluding Japan) | 425 participants | 210 participants | 215 participants | 0 participants |
| Geographic Region European Union (EU)/United States (US) | 172 participants | 83 participants | 89 participants | 0 participants |
| Geographic Region Japan | 87 participants | 39 participants | 38 participants | 10 participants |
| Macrovascular Invasion Absent | 585 Participants | 284 Participants | 291 Participants | 10 Participants |
| Macrovascular Invasion Present | 99 Participants | 48 Participants | 51 Participants | 0 Participants |
| Race/Ethnicity, Customized American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Asian | 515 Participants | 250 Participants | 255 Participants | 10 Participants |
| Race/Ethnicity, Customized Black or African American | 5 Participants | 2 Participants | 3 Participants | 0 Participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Not Reported | 15 Participants | 6 Participants | 9 Participants | 0 Participants |
| Race/Ethnicity, Customized Other | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Unknown | 5 Participants | 1 Participants | 4 Participants | 0 Participants |
| Race/Ethnicity, Customized White | 144 Participants | 73 Participants | 71 Participants | 0 Participants |
| Sex: Female, Male Female | 107 Participants | 51 Participants | 53 Participants | 3 Participants |
| Sex: Female, Male Male | 577 Participants | 281 Participants | 289 Participants | 7 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 7 / 10 | 258 / 338 | 273 / 324 | 1 / 684 |
| other Total, other adverse events | 8 / 10 | 313 / 338 | 318 / 324 | 0 / 0 |
| serious Total, serious adverse events | 1 / 10 | 104 / 338 | 91 / 324 | 7 / 684 |
Outcome results
Main Study: Overall Survival (OS)
Defined as the time from the date of randomization to the date of death due to any cause. Median OS was estimated using Kaplan-Meier methodology. Overall survival was a pre-specified primary endpoint for the main study only.
Time frame: Through the primary analysis data cut-off date of July 11th, 2022 (up to approximately 55 months)
Population: The Intent-To-Treat (ITT) analysis set included all randomized participants in the main study.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Safety Run-In Sub-study | Main Study: Overall Survival (OS) | 15.9 Months |
| Arm B: Sorafenib | Main Study: Overall Survival (OS) | 14.1 Months |
Safety Run-in Sub-study: Number of Participants With Treatment-emergent Adverse Events (TEAEs)
An adverse event (AE) is any unfavorable or unintended sign (e.g., abnormal lab result), symptom, or disease temporally associated with study drug use, regardless of causality. A serious adverse event (SAE) is defined as any adverse event that: * Resulted in death * Was life-threatening * Required or prolonged hospitalization * Caused disability/incapacity * Lead to a congenital anomaly/birth defect * Was deemed medically significant by the investigator (e.g., required intervention to prevent severe outcomes).
Time frame: From the first dose to 30 days after the last dose, new anticancer therapy, or the analysis cutoff of December 14th, 2023 (a maximum of 64 months)
Population: The Sub-study Safety Analysis Set includes all participants in the safety run-in sub-study who received at least one dose of any study drug.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Safety Run-In Sub-study | Safety Run-in Sub-study: Number of Participants With Treatment-emergent Adverse Events (TEAEs) | TEAEs | 8 Participants |
| Safety Run-In Sub-study | Safety Run-in Sub-study: Number of Participants With Treatment-emergent Adverse Events (TEAEs) | SAEs | 1 Participants |
Safety Run-in Sub-study: Serum Concentration of Tislelizumab
Serum concentration of tislelizumab was a pre-specified primary endpoint for the sub-study only.
Time frame: Cycle 1 and Cycle 5 at end of infusion, 24 hand 72 hours post-dose, and 8 days and 15 days post-dose (each cycle was 3 weeks).
Population: The Sub-study Pharmacokinetic (PK) Analysis Set includes all participants in the safety run-in sub-study who received at least 1 dose of tislelizumab per the protocol, for whom any post-dose PK data were available at each time point.
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|---|
| Safety Run-In Sub-study | Safety Run-in Sub-study: Serum Concentration of Tislelizumab | Cycle 1 End of Infusion | 63.21 µg/mL | Geometric Coefficient of Variation 22.304 |
| Safety Run-In Sub-study | Safety Run-in Sub-study: Serum Concentration of Tislelizumab | Cycle 1: 24 Hours Post Dose | 53.04 µg/mL | Geometric Coefficient of Variation 20.901 |
| Safety Run-In Sub-study | Safety Run-in Sub-study: Serum Concentration of Tislelizumab | Cycle 1: 72 Hours Post Dose | 42.06 µg/mL | Geometric Coefficient of Variation 23.649 |
| Safety Run-In Sub-study | Safety Run-in Sub-study: Serum Concentration of Tislelizumab | Cycle 1: 8 Days Post Dose | 32.61 µg/mL | Geometric Coefficient of Variation 16.92 |
| Safety Run-In Sub-study | Safety Run-in Sub-study: Serum Concentration of Tislelizumab | Cycle 1: 15 Days Post Dose | 23.74 µg/mL | Geometric Coefficient of Variation 18.328 |
| Safety Run-In Sub-study | Safety Run-in Sub-study: Serum Concentration of Tislelizumab | Cycle 5 Day 1: Predose | 27.17 µg/mL | Geometric Coefficient of Variation 34.436 |
| Safety Run-In Sub-study | Safety Run-in Sub-study: Serum Concentration of Tislelizumab | Cycle 5 Day 1: End of Infusion | 87.54 µg/mL | Geometric Coefficient of Variation 27.508 |
| Safety Run-In Sub-study | Safety Run-in Sub-study: Serum Concentration of Tislelizumab | Cycle 5: 24 Hours Post Dose | 80.54 µg/mL | Geometric Coefficient of Variation 27.006 |
| Safety Run-In Sub-study | Safety Run-in Sub-study: Serum Concentration of Tislelizumab | Cycle 5: 72 Hours Post Dose | 64.80 µg/mL | Geometric Coefficient of Variation 23.837 |
| Safety Run-In Sub-study | Safety Run-in Sub-study: Serum Concentration of Tislelizumab | Cycle 5: 8 Days Post Dose | 52.65 µg/mL | Geometric Coefficient of Variation 26.759 |
| Safety Run-In Sub-study | Safety Run-in Sub-study: Serum Concentration of Tislelizumab | Cycle 5: 15 Days Post Dose | 37.57 µg/mL | Geometric Coefficient of Variation 24.982 |
Change From Baseline in the EORTC QLQ-C30 Global Health Status/Quality of Life Score at Cycle 6
The EORTC QLQ-C30 v3.0 is a questionnaire that assesses quality of life of participants with cancer. It includes global health status and quality of life questions related to overall health in which participants respond based on a 7-point scale, where 1 is very poor and 7 is excellent. Raw scores are transformed into a 0 to 100 scale via linear transformation. A higher score indicates better health outcomes. The EORTC QLQ-C30 was not assessed in participants in the sub-study.
Time frame: Baseline to Cycle 6 (each cycle was 21 days)
Population: ITT Analysis Set. Only participants with data at both Baseline and Cycle 6 are included.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Safety Run-In Sub-study | Change From Baseline in the EORTC QLQ-C30 Global Health Status/Quality of Life Score at Cycle 6 | -0.9 score on a scale |
| Arm B: Sorafenib | Change From Baseline in the EORTC QLQ-C30 Global Health Status/Quality of Life Score at Cycle 6 | -5.9 score on a scale |
Change From Baseline in the EQ-5D-5L VAS at Cycle 6
The EQ-5D-5L comprises a descriptive module and a visual analogue scale (VAS). The EQ-5D-5L VAS measures respondent's self-rated health status on a 0 to 100 scale, with 100 = 'the best health you can imagine' and 0 = 'the worst health you can imagine'. Higher scores on VAS indicate higher health status. The EQ-5D-5L VAS was not assessed in participants in the sub-study.
Time frame: Baseline to Cycle 6 (each cycle was 21 days)
Population: ITT Analysis Set. Only participants with data at both Baseline and Cycle 6 are included in the analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Safety Run-In Sub-study | Change From Baseline in the EQ-5D-5L VAS at Cycle 6 | -0.2 score on a scale | Standard Deviation 17.03 |
| Arm B: Sorafenib | Change From Baseline in the EQ-5D-5L VAS at Cycle 6 | -5.4 score on a scale | Standard Deviation 13.09 |
Change From Baseline in the European EORTC QLQ HCC 18 Index Score at Cycle 6
The EORTC QLQ-HCC18 is a questionnaire specifically designed to assess health-related quality of life in participants with hepatocellular carcinoma. It includes six symptom scales measuring Fatigue (3 items), Jaundice (2 items), Body Image (2 items), Nutrition (5 items), Pain (2 items), Fever (2 items) and two single items measuring Sex Life and Abdominal Swelling. Participants respond on a scale from 1 = Not at all to 4 = Very Much. Raw scores are transformed into a 0 to 100 scale using linear transformation. The HCC18 Index score is calculated from each of the 6 symptom scales and the 2 single items, and ranges from 0 to 100. Higher scores indicate greater symptom burden or worse quality of life. The HEORTC QLQ-HCC18 was not assessed in participants in the sub-study.
Time frame: Baseline to Cycle 6 (Each cycle was 21 days)
Population: ITT Analysis Set. Only participants with data at both baseline and Cycle 6 are included
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Safety Run-In Sub-study | Change From Baseline in the European EORTC QLQ HCC 18 Index Score at Cycle 6 | 2.2 score on a scale |
| Arm B: Sorafenib | Change From Baseline in the European EORTC QLQ HCC 18 Index Score at Cycle 6 | 4.9 score on a scale |
Change From Baseline in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Hepatocellular Carcinoma 18 Questions (EORTC QLQ HCC 18) Index Score at Cycle 4
The EORTC QLQ-HCC18 is a questionnaire specifically designed to assess health-related quality of life in participants with hepatocellular carcinoma. It includes six symptom scales measuring Fatigue (3 items), Jaundice (2 items), Body Image (2 items), Nutrition (5 items), Pain (2 items), Fever (2 items) and two single items measuring Sex Life and Abdominal Swelling. Participants respond on a scale from 1 = Not at all to 4 = Very Much. Raw scores are transformed into a 0 to 100 scale using linear transformation. The HCC18 Index score is calculated from each of the 6 symptom scales and the 2 single items, and ranges from 0 to 100. Higher scores indicate greater symptom burden or worse quality of life. The EORTC QLQ-HCC18 was not assessed for participants in the sub-study.
Time frame: Baseline to Cycle 4 (each cycle was 21 days)
Population: ITT Analysis Set. Only participants with data at both Baseline and Cycle 4 are included
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Safety Run-In Sub-study | Change From Baseline in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Hepatocellular Carcinoma 18 Questions (EORTC QLQ HCC 18) Index Score at Cycle 4 | 1.6 score on a scale |
| Arm B: Sorafenib | Change From Baseline in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Hepatocellular Carcinoma 18 Questions (EORTC QLQ HCC 18) Index Score at Cycle 4 | 3.9 score on a scale |
Change From Baseline in the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status/Quality of Life Score at Cycle 4
The EORTC QLQ-C30 v3.0 is a questionnaire that assesses quality of life of participants with cancer. It includes global health status and quality of life questions related to overall health in which participants respond based on a 7-point scale, where 1 is very poor and 7 is excellent. Raw scores are transformed into a 0 to 100 scale via linear transformation. A higher score indicates better health outcomes. The EORTC QLQ-C30 was not assessed in participants in the sub-study.
Time frame: Baseline to Cycle 4 (each cycle was 21 days)
Population: ITT Analysis Set. Only participants with data at both Baseline and Cycle 4 are included.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Safety Run-In Sub-study | Change From Baseline in the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status/Quality of Life Score at Cycle 4 | -0.7 score on a scale |
| Arm B: Sorafenib | Change From Baseline in the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) Global Health Status/Quality of Life Score at Cycle 4 | -5.1 score on a scale |
Change From Baseline in the European Quality of Life 5 Dimensions, 5-level (EQ-5D-5L) Visual Analogue Scale (VAS) at Cycle 4
The EQ-5D-5L comprises a descriptive module and a Visual Analogue scale (VAS). The EQ-5D-5L VAS measures respondent's self-rated health status on a 0 to 100 scale, with 100 = 'the best health you can imagine' and 0 = 'the worst health you can imagine'. Higher scores on VAS indicate higher health status. The EQ-5D-5L VAS was not assessed in participants in the sub-study.
Time frame: Baseline to Cycle 4 (each cycle was 21 days)
Population: ITT Analysis Set. Only participants with data at both Baseline and Cycle 4 are included in the analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Safety Run-In Sub-study | Change From Baseline in the European Quality of Life 5 Dimensions, 5-level (EQ-5D-5L) Visual Analogue Scale (VAS) at Cycle 4 | -0.4 score on a scale | Standard Deviation 14.52 |
| Arm B: Sorafenib | Change From Baseline in the European Quality of Life 5 Dimensions, 5-level (EQ-5D-5L) Visual Analogue Scale (VAS) at Cycle 4 | -4.3 score on a scale | Standard Deviation 12.92 |
Clinical Benefit Rate (CBR) as Assessed by BIRC
Defined as the percentage of participants whose best overall response (BOR) was complete response, partial response, or stable disease greater than or equal to 24 weeks in duration, as assessed by the BIRC per RECIST v1.1. CBR was not a pre-specified endpoint for participants in the sub-study.
Time frame: Through the primary analysis data cut-off date of July 11th, 2022 (up to approximately 55 months)
Population: ITT Analysis Set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Safety Run-In Sub-study | Clinical Benefit Rate (CBR) as Assessed by BIRC | 25.4 percentage of participants |
| Arm B: Sorafenib | Clinical Benefit Rate (CBR) as Assessed by BIRC | 24.4 percentage of participants |
Clinical Benefit Rate (CBR) as Assessed by the Investigator
Defined as the percentage of participants whose best overall response (BOR) is complete response, partial response, or stable disease greater than or equal to 24 weeks in duration, as assessed by the investigator per RECIST v1.1. CBR was not a pre-specified endpoint for participants in the sub-study.
Time frame: Through the study completion data cut-off date of December 14th, 2023 (up to approximately 65 months)
Population: ITT Analysis Set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Safety Run-In Sub-study | Clinical Benefit Rate (CBR) as Assessed by the Investigator | 25.7 percentage of participants |
| Arm B: Sorafenib | Clinical Benefit Rate (CBR) as Assessed by the Investigator | 28.9 percentage of participants |
Disease Control Rate (DCR) as Assessed by BIRC
Defined as the percentage of participants whose best overall response (BOR) was complete response, partial response, or stable disease as assessed by the BIRC per RECIST v1.1. DCR was not a pre-specified endpoint for participants in the sub-study.
Time frame: Through the primary analysis data cut-off date of July 11th, 2022 (up to approximately 55 months)
Population: ITT Analysis Set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Safety Run-In Sub-study | Disease Control Rate (DCR) as Assessed by BIRC | 44.2 percentage of participants |
| Arm B: Sorafenib | Disease Control Rate (DCR) as Assessed by BIRC | 50.3 percentage of participants |
Disease Control Rate (DCR) as Assessed by the Investigator
Defined as the percentage of participants whose best overall response (BOR) was complete response, partial response, or stable disease as assessed by the investigator per RECIST v1.1. DCR was not a pre-specified endpoint for participants in the sub-study.
Time frame: Through the study completion data cut-off date of December 14th, 2023 (up to approximately 65 months)
Population: ITT Analysis Set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Safety Run-In Sub-study | Disease Control Rate (DCR) as Assessed by the Investigator | 44.2 percentage of participants |
| Arm B: Sorafenib | Disease Control Rate (DCR) as Assessed by the Investigator | 52.4 percentage of participants |
Duration of Response (DOR) as Assessed by BIRC
Defined as the time from the first occurrence of a documented objective response until the first documentation of progression or death from any cause, whichever occurred first, as determined by the BIRC per RECIST v1.1. Median DOR was estimated using Kaplan-Meier methodology. DOR was not assessed by the BIRC for participants in the sub-study, and this was not a pre-specified sub-study endpoint.
Time frame: Through the primary analysis data cut-off date of July 11th, 2022 (up to approximately 55 months)
Population: ITT Analysis Set. Only participants with best overall response of complete response or partial response confirmed per RECIST v1.1 were included in the analysis, and percentages were based on the number of responders.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Safety Run-In Sub-study | Duration of Response (DOR) as Assessed by BIRC | 36.1 months |
| Arm B: Sorafenib | Duration of Response (DOR) as Assessed by BIRC | 11.0 months |
Duration of Response (DOR) Assessed by the Investigator
Defined as the time from the first occurrence of a documented objective response until the first documentation of progression or death from any cause, whichever occurred first, as assessed by the investigator per RECIST v1.1. Median DOR was estimated using Kaplan-Meier methodology.
Time frame: Through the study completion data cut-off date of December 14th, 2023 (up to approximately 65 months)
Population: Sub-study Safety Analysis Set; Main study ITT Analysis Set; Only participants with best overall response of complete response or partial response per investigator assessment were included in the analysis.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Safety Run-In Sub-study | Duration of Response (DOR) Assessed by the Investigator | NA Months |
| Arm B: Sorafenib | Duration of Response (DOR) Assessed by the Investigator | 25.2 Months |
| Arm B: Sorafenib | Duration of Response (DOR) Assessed by the Investigator | 13.8 Months |
Main Study: Number of Participants With Treatment-emergent Adverse Events
An adverse event (AE) is any unfavorable or unintended sign (e.g., abnormal lab result), symptom, or disease temporally associated with study drug use, regardless of causality. A serious adverse event (SAE) is defined as any adverse event that: * Resulted in death * Was life-threatening * Required or prolonged hospitalization * Caused disability/incapacity * Lead to a congenital anomaly/birth defect * Was deemed medically significant by the investigator (e.g., required intervention to prevent severe outcomes).
Time frame: From the first dose to 30 days after the last dose, new anticancer therapy, or the study completion analysis cutoff on December 14th, 2023 (a maximum of 61 months for participants in Arm A and 63 months for participants in Arm B).
Population: The Safety Analysis Set includes all randomized participants who received at least one dose of any study drug.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Safety Run-In Sub-study | Main Study: Number of Participants With Treatment-emergent Adverse Events | TEAEs | 325 Participants |
| Safety Run-In Sub-study | Main Study: Number of Participants With Treatment-emergent Adverse Events | SAEs | 104 Participants |
| Arm B: Sorafenib | Main Study: Number of Participants With Treatment-emergent Adverse Events | TEAEs | 324 Participants |
| Arm B: Sorafenib | Main Study: Number of Participants With Treatment-emergent Adverse Events | SAEs | 91 Participants |
Overall Response Rate (ORR) as Assessed by Blinded Independent Review Committee (BIRC)
Defined as the percentage of participants who had partial response or complete response as determined by Blinded Independent Review Committee (BIRC) per the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 in all randomized participants with measurable disease at baseline. ORR was not assessed by the BIRC for participants in the sub-study, and this was not a pre-specified sub-study endpoint.
Time frame: Through the primary analysis data cut-off date of July 11th, 2022 (up to approximately 55 months)
Population: ITT Analysis Set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Safety Run-In Sub-study | Overall Response Rate (ORR) as Assessed by Blinded Independent Review Committee (BIRC) | 14.3 percentage of participants |
| Arm B: Sorafenib | Overall Response Rate (ORR) as Assessed by Blinded Independent Review Committee (BIRC) | 5.4 percentage of participants |
Overall Response Rate (ORR) as Assessed by the Investigator
Defined as the percentage of participants who had partial response or complete response as determined by the investigator per RECIST v1.1 in all randomized participants with measurable disease at baseline.
Time frame: Through the study completion data cut-off date of December 14th, 2023 (up to approximately 65 months)
Population: Sub-study Safety Analysis Set; Main study ITT Analysis Set
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Safety Run-In Sub-study | Overall Response Rate (ORR) as Assessed by the Investigator | 20 percentage of participants |
| Arm B: Sorafenib | Overall Response Rate (ORR) as Assessed by the Investigator | 15.5 percentage of participants |
| Arm B: Sorafenib | Overall Response Rate (ORR) as Assessed by the Investigator | 5.7 percentage of participants |
Progression Free Survival (PFS) as Assessed by BIRC
Defined as the time from randomization to the first objectively documented disease progression, or death from any cause, whichever occurred first, as assessed by the BIRC per RECIST v1.1. Kaplan-Meier methodology was used to estimate the median PFS. PFS was not assessed by the BIRC for participants in the sub-study, and this was not a pre-specified sub-study endpoint.
Time frame: Through the primary analysis data cut-off date of July 11th, 2022 (up to approximately 55 months)
Population: ITT Analysis Set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Safety Run-In Sub-study | Progression Free Survival (PFS) as Assessed by BIRC | 2.1 months |
| Arm B: Sorafenib | Progression Free Survival (PFS) as Assessed by BIRC | 3.4 months |
Progression Free Survival (PFS) Assessed by the Investigator
Defined as the time from randomization to the first objectively documented disease progression, or death from any cause, whichever occurred first, as assessed by the investigator per RECIST v1.1. Kaplan-Meier methodology was used to estimate the median PFS.
Time frame: Through the study completion data cut-off date of December 14th, 2023 (up to approximately 65 months)
Population: Sub-study Safety Analysis Set; Main study ITT Analysis Set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Safety Run-In Sub-study | Progression Free Survival (PFS) Assessed by the Investigator | 2.1 Months |
| Arm B: Sorafenib | Progression Free Survival (PFS) Assessed by the Investigator | 2.1 Months |
| Arm B: Sorafenib | Progression Free Survival (PFS) Assessed by the Investigator | 4.0 Months |
Safety Run-in Sub-study: Number of Participants Who Developed Anti-tislelizumab Antibodies
Treatment-emergent anti-drug antibodies (ADA): participants who were ADA negative at baseline and ADA positive post-baseline. Treatment-boosted ADA: participants who were ADA positive at baseline that was boosted to a 4-fold or higher-level following drug administration. ADA assessments were not performed for participants enrolled in the main study.
Time frame: From the first dose to 30 days after the last dose, new anticancer therapy, or the analysis cutoff of December 14th, 2023 (a maximum of 64 months)
Population: The Sub-study Antidrug antibody (ADA) Analysis Set includes all participants enrolled in the sub-study who received at least one dose of tislelizumab for whom both baseline ADA and at least one postbaseline ADA results were available.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Safety Run-In Sub-study | Safety Run-in Sub-study: Number of Participants Who Developed Anti-tislelizumab Antibodies | Treatment-Emergent ADA | 1 Participants |
| Safety Run-In Sub-study | Safety Run-in Sub-study: Number of Participants Who Developed Anti-tislelizumab Antibodies | Treatment-Boosted ADA | 0 Participants |
Safety Run-in Sub-study: Overall Survival
Defined as the time from the date of randomization to the date of death due to any cause. Median OS was estimated using Kaplan-Meier methodology.
Time frame: Up a to 64 months
Population: Sub-study Safety Analysis Set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Safety Run-In Sub-study | Safety Run-in Sub-study: Overall Survival | 29.7 months |
Time to Progression (TTP) as Assessed by the Investigator
Defined as the time from the date of randomization to the date of the first objectively documented tumor progression as assessed by the investigator per RECIST v1.1. Median TTP was estimated using Kaplan-Meier methodology. TTP was not a pre-specified sub-study endpoint.
Time frame: Through the study completion data cut-off date of December 14th, 2023 (up to approximately 65 months)
Population: ITT Analysis Set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Safety Run-In Sub-study | Time to Progression (TTP) as Assessed by the Investigator | 2.1 months |
| Arm B: Sorafenib | Time to Progression (TTP) as Assessed by the Investigator | 4.1 months |
Time to Progression (TTP) Assessed by BIRC
Defined as the time from the date of randomization to the date of the first objectively documented tumor progression as assessed by the BIRC per RECIST v1.1. Median TTP was estimated using Kaplan-Meier methodology. TTP was not assessed by the BIRC for participants in the sub-study, and this was not a pre-specified sub-study endpoint.
Time frame: Through the primary analysis data cut-off date of July 11th, 2022 (up to approximately 55 months)
Population: ITT Analysis Set
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Safety Run-In Sub-study | Time to Progression (TTP) Assessed by BIRC | 2.2 Months |
| Arm B: Sorafenib | Time to Progression (TTP) Assessed by BIRC | 4.1 Months |