Stage III Hepatocellular Carcinoma AJCC v8Phase 2NCT03439891
Sorafenib and Nivolumab in Treating Participants With Unresectable, Locally Advanced or Metastatic Liver Cancer
A Phase 2 study testing Nivolumab and Sorafenib in people with Stage III Hepatocellular Carcinoma AJCC v8 and Stage IIIA Hepatocellular Carcinoma AJCC v8, run by Robin Kate Kelley at 2 sites in United States.
Trial summary
This phase II trial studies the best dose and side effects of sorafenib tosylate and nivolumab in treating patients with liver cancer that cannot be removed by surgery (unresectable), has spread to nearby tissues or lymph nodes (locally advanced) or to other places in the body (metastatic). Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Stage III Hepatocellular Carcinoma AJCC v8, Stage IIIA Hepatocellular Carcinoma AJCC v8, Stage IIIB Hepatocellular Carcinoma AJCC v7
- What is being tested?
- Nivolumab and Sorafenib
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 16 participants
- Where
- 2 sitesUnited States
- Study dates
- 16 Apr 2018to 30 Nov 2023
- Phase
- Phase 2
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Histologic or cytologic diagnosis of unresectable, locally advanced and/or metastatic hepatocellular carcinoma (HCC) not amenable to curative surgery, transplantation, or ablative therapies based upon assessment of treating investigator.
- For patients without prior histologic or cytologic diagnosis, radiographic diagnosis is allowed provided patients meet American Association for the Study of Liver Diseases (AASLD) criteria for radiographic diagnosis.
- Radiographically measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 in at least one site not previously treated with chemoembolization, radioembolization, radiation, or other local/liver-directed procedures (i.e. must have at least one measurable target lesion, either within the liver or in a measurable metastatic site); a new area of tumor progression within or adjacent to a previously-treated lesion, if clearly measurable by a radiologist, is acceptable.
- Untreated/pretreatment archival tumor tissue must be available for correlative analyses
- Age at least 18 years at enrollment.
- Eastern Cooperative Oncology Group (ECOG) 0 or 1 at enrollment
Show all 30Show fewer
- At least 4 weeks after any prior chemoembolization, radioembolization, local ablative therapies, or hepatic radiation and recovery to =< grade 1 treatment-related toxicity.
- At least 6 weeks after any major surgery including prior hepatic resection and recovery to =< grade 1 treatment-related toxicity.
- At least 7 days after minor surgery (such as central venous access) or biopsy and recovery to =< grade 1 treatment-related toxicity
- At least 2 weeks after any prior palliative radiation (e.g. to focal metastatic lesion such as bone metastases) and recovery to =< grade 1 treatment-related toxicity.
- Blood pressure =< 140/90 mm Hg with or without anti-hypertensive therapy
- Patients may be rescreened after initial ineligibility if due to elevated blood pressure, if adequately medically managed within approximately 30 days.
- Adequate baseline organ and marrow function as defined below:
- Adequate bone marrow function:
- Absolute neutrophil count at least 1,200/microliter (mcL).
- Platelets at least 50,000/mcL.
- Hemoglobin at least 9 g/dL.
- Adequate hepatic function:
- Part 1: Total bilirubin less than 2.6 mg/dL or 2 times upper limit of normal (ULN), whichever is higher, and albumin at least 2.5 g/dL, if otherwise meets criteria for Child Pugh A or B7.
- Part 2: Total bilirubin less than 3.9 mg/dL or 3 times ULN, whichever is higher, and albumin at least 2.0 g/dL, if otherwise meets criteria for Child Pugh B.
- Both Parts: Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase (SGOT)) and alanine aminotransferase (ALT) (serum glutamic-pyruvic transaminase (SGPT)) less than 5 X ULN, International normalized ratio (INR) less than 1.7.
- Creatinine less than 1. 5 X ULN and/or creatinine clearance >= 60 mL/min.
- Child-Pugh A or B7 (Part 1); Child-Pugh B7-9 (Part 2).
- If HBV surface antigen (sAg) and/or core antibody (Ab) positive, must be treated with appropriate antiviral therapy according to institutional practice with HBV deoxyribonucleic acid (DNA) by polymerase chain reaction (PCR) less than 500 IU/mL.
- If clinical or histologic diagnosis of cirrhosis and/or clinical or radiographic evidence esophageal or gastric varices, must have had esophagogastroduodenoscopy (EGD) surveillance and adequate endoscopic therapy according to institutional standards.
- Able to swallow and retain oral medications
- Women of child-bearing potential (WOCBP) must have a negative pregnancy test within 28 days before study enrollment.
- WOCBP and male partners of WOCBP must agree to use two methods of contraception until at least 5 months after last dose of each study drug for WOCBP subjects, and 7 months for male partners of WOCBP.
- Able to understand and willingness to provide informed consent, and the willingness to comply with the requirements of the protocol.
- Subjects must have signed and dated an Institutional Review Board (IRB)/Independent Ethics Committees (IEC) approved written informed consent form in accordance with regulatory and institutional guidelines and before the performance of any protocol related procedures that are not part of standard of care.
Who cannot join
- Any prior systemic therapy for HCC.
- Known fibrolamellar or mixed HCC-cholangiocarcinoma histology.
- Requirement for paracentesis to control ascites within 6 months before enrollment.
- Ascites which is not clinically detectable or mild on stable doses of diuretics during screening is allowed provided meets criteria for Child Pugh A or B7 (Part 1) or B7-9 (Part 2).
- Symptomatic hepatic encephalopathy requiring medication (such as lactulose or rifaximin) (Part 1) or any hospitalization for encephalopathy within 6 months before enrollment (Part 1 or 2).
- Hepatic encephalopathy that is adequately controlled on stable doses of lactulose and/or rifaximin per assessment of treating investigator is allowed in Part 2, provided no hospitalization for encephalopathy within 6 months before enrollment.
Show all 43Show fewer
- Medications such as lactulose used for other indications (e.g. constipation) are allowed in both Part 1 and 2.
- History of upper gastrointestinal (GI) bleeding from esophageal and/or gastric varices within 12 months before enrollment.
- Requirement for systemic corticosteroids unless used for adrenal replacement, acute therapy for asthma or bronchitis exacerbation (=< 2 weeks), or premedication for contrast allergy.
- Topical, intranasal, or inhaled steroids are not excluded.
- Active autoimmune condition requiring systemic immunosuppressive medication.
- Known human immunodeficiency virus (HIV) infection.
- Active coinfection with HBV plus hepatitis delta (D) virus (HDV) or HCV:
- Both hepatitis B and C as evidenced by detectable HBV surface antigen or HBV DNA and detectable HCV ribonucleic acid (RNA).
- Hepatitis D infection (HDV antibody positive) in subjects with detectable hepatitis B surface antigen or HBV DNA.
- Prior allogeneic transplant of any solid organ or bone marrow/stem cells.
- Symptomatic hypothyroidism without replacement.
- Patients may be rescreened after initiating adequate replacement therapy
- History of seizure disorder requiring antiepileptic medication or brain metastases with seizures.
- Non-healing wound, ulcer, non-healing traumatic bone fracture, or abscess within 30 days of enrollment.
- Nondisplaced, uncomplicated pathologic fracture due to tumor may be eligible provided adequately treated with radiation, surgery or other treatments with full recovery based upon investigator assessment.
- Central or necrotic lung metastases.
- Known brain or leptomeningeal metastases.
- Uncontrolled hypertension (systolic pressure > 140 mm Hg and/or diastolic pressure > 90 mm Hg (National Cancer Institute (NCI)-Common Terminology Criteria for Adverse Events (CTCAE) v4.0) on repeated measurement) despite optimal medical management.
- Active or clinically significant cardiac disease including:
- Congestive heart failure - New York Heart Association (NYHA) > class II.
- Active coronary artery disease including unstable or newly diagnosed angina or myocardial infarction within 6 months prior to study entry.
- Cardiac arrhythmias requiring anti-arrhythmic therapy other than beta blockers or digoxin.
- Corrected QT interval (QTc) (Fridericia) > 450 msec on two consecutive electrocardiograms (ECGs) (baseline ECG should be repeated if QTc is found to be > 450 msec).
- Subject with any pulmonary hemorrhage/bleeding event of NCI-CTCAE v4.0 grade 2 or higher within 6 months before first dose of study treatment any other hemorrhage/bleeding event of NCI-CTCAE v4.0 grade 3 or higher within 6 months before first dose of study treatment.
- Subjects with arterial or venous thrombotic or embolic, such as cerebrovascular accident (including transient ischemic attacks), myocardial infarction, or deep venous thrombosis (DVT) within 6 months of informed consent.
- Tumor or bland thrombus in hepatic vasculature is not an exclusion provided hepatic function criteria are met.
- Asymptomatic thromboembolic events such as incidentally-detected sub-segmental pulmonary emboli or superficial thromboses are not an exclusion provided the patient does not require treatment with therapeutic anticoagulation.
- Subjects who have used strong CYP3A4 inducers (eg, phenytoin, carbamazepine, phenobarbital, St. John's wort (hypericum perforatum), dexamethasone at a dose of greater than 16 mg daily, or rifampin [rifampicin], and/or rifabutin) within 28 days before first dose of study treatment.
- Subjects who require therapeutic anticoagulation or anti-platelet therapy.
- Low dose aspirin (=< 100 mg/day) is allowed
- Prophylactic doses of low molecular weight heparin (LMWH) are allowed if approved by study chair or designee.
- Subjects with any previously untreated and concurrent cancer that is distinct in primary site or histology from HCC except cervical cancer in-situ, treated nonmelanoma skin cancers, localized prostate cancer not requiring systemic therapy undergoing surveillance, or superficial bladder tumor; subjects surviving a cancer that was curatively treated and without evidence of disease for more than 2 years before enrollment are allowed provided that cancer therapy was completed at least 2 years prior to study entry (date of the informed consent form).
- Any uncontrolled intercurrent illness including, but not limited to: ongoing or active infection requiring antibiotic therapy, pulmonary disease impairing functional status or requiring oxygen, impairment in gastrointestinal function that may affect or alter absorption of oral medications (such as malabsorption or history of gastrectomy or bowel resection), or uncontrolled diarrhea.
- Known or suspected allergy or hypersensitivity to any of the study drugs, study drug classes, or excipients of the formulations given during the course of this trial
- Women who are pregnant or breast-feeding at enrollment
- Inability to comply with the protocol and/or not willing or not available for follow-up assessments.
- Any condition which, in the investigator's opinion, makes the subject unsuitable for trial participation
Trial locations and contacts
2 sites in 1 country.
United States2 sites
University of California, Davis
Sacramento, California, 95817
University of California, San Francisco
San Francisco, California, 94143
About this study
Official title: Multicenter Pilot Study of the Safety, Efficacy, and Immune Cell Profiling in Advanced Hepatocellular Carcinoma (HCC) Patients Treated With the Combination of Sorafenib Plus Nivolumab as First-Line of Systemic Therapy
This phase II trial studies the best dose and side effects of sorafenib tosylate and nivolumab in treating patients with liver cancer that cannot be removed by surgery (unresectable), has spread to nearby tissues or lymph nodes (locally advanced) or to other places in the body (metastatic). Sorafenib tosylate may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Giving sorafenib tosylate and nivolumab may work better in treating patients with liver cancer.
Read the detailed description
PRIMARY OBJECTIVES:
- Maximum tolerated dose (MTD) of sorafenib tosylate (sorafenib) in combination with standard dose nivolumab with Child Pugh A-B7 liver function. (Part 1: Escalation Cohort).
II. Safety in participants with Child-Pugh B liver function. (Part 2: Child-Pugh B Escalation Cohort)
SECONDARY OBJECTIVES:
- Safety and tolerability of combination overall. (Parts 1 and 2).
II. Rate of immune-related adverse event (irAE) for combination overall and in participants with Child-Pugh B liver function. (Parts 1 and 2).
III. Overall response rate (ORR) by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 in participants with Child-Pugh B liver function. (Parts 1 and 2).
IV. Duration of response (DOR), progression free survival (PFS), and overall survival (OS) for escalation cohort and Child-Pugh B expansion cohort and overall. (Parts 1 and 2).
EXPLORATORY OBJECTIVES:
- Relationship between peripheral blood mononuclear cell (PBMC) immune cell subset frequencies, baseline liver function, and clinical outcomes.
II. Relationship between PBMC T cell receptor (TCR) clonotype frequency and diversity, baseline liver function, and clinical outcomes.
III. Tumor tissue immune cell subsets and TCR clonotype frequency and diversity in pre-treatment archival tumor tissue samples.
IV. Tumor and immune cell programmed death-ligand 1 (PD-L1) status in pre-treatment archival tumor tissue samples and relationship to clinical outcomes.
- Changes in hepatitis B virus (HBV) and/or hepatitis C virus (HCV) viral load on treatment.
VI. Alpha-fetoprotein (AFP) changes on treatment and relationship to clinical outcomes.
VII. Relationship between clinical outcomes and clinicopathologic features including race/ethnicity, etiology of liver disease including HBV/HCV status, baseline liver function, presence of cirrhosis, macrovessel invasion, extrahepatic spread, site(s) of metastatic disease, prior treatment history including prior radiation and arterial therapies.
OUTLINE: This is a dose-escalation and expansion study of sorafenib tosylate.
DOSE-ESCALATION (Part 1):
Between 3-12 participants will be enrolled in Part 1. Participants receive sorafenib tosylate orally (PO) once daily (QD) or twice daily (BID) on days 1-28, and nivolumab intravenously (IV) over 30 minutes on days 1 and 15. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
EXPANSION COHORT (Part 2).
Participants receive nivolumab IV over 30 minutes on days 1 and 15, and sorafenib tosylate once daily (QD) or twice daily (BID) on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, participants are followed up at 30 and 100 days, then every 3 months for up to 2 years after the last dose.
- Conditions
- Stage III Hepatocellular Carcinoma AJCC v8, Stage IIIA Hepatocellular Carcinoma AJCC v8, Stage IIIB Hepatocellular Carcinoma AJCC v7, Stage IIIC Hepatocellular Carcinoma AJCC v7, Stage IV Hepatocellular Carcinoma AJCC v8, Stage IVA Hepatocellular Carcinoma AJCC v8
- Medical subject headings
- Carcinoma, Hepatocellular
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
NivolumabBiological
Also called BMS-936558, MDX-1106, NIVO, ONO-4538
Given IV
SorafenibDrug
Also called BAY 43-9006
Given PO
| Study group | Role | What they receive |
|---|---|---|
| Part 1: Starting Dose Schedule (DL -1) Once a day | Experimental | Participants with Child-Pugh A or B7 receive a daily dose of 400mg sorafenib on days 1-28, and 240mg of nivolumab IV over 30 minutes beginning on day 15 of course 1, then on days 1 and 15 of subsequent courses. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Course will continue until 1 dose-limiting toxicity occurs to establish maximum tolerated dosing schedule. Receives: Biological: Nivolumab; Drug: Sorafenib |
| Part 1: Escalated Dose Schedule (DL 1) Twice a day | Experimental | Participants with Child-Pugh A or B7 receive a daily dose of 400mg sorafenib twice a day on days 1-28, and 240mg of nivolumab IV over 30 minutes beginning on day 15 of course 1, then on days 1 and 15 of subsequent courses. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Course will continue until 1 dose-limiting toxicity occurs to establish maximum tolerated dosing schedule. Receives: Biological: Nivolumab; Drug: Sorafenib |
| Part 2: Child-Pugh B (CPB) Expansion Cohort (sorafenib, nivolumab) | Experimental | Participants with Child-Pugh B7-9 receive sorafenib at the maximum tolerated dose (MTD) established in Part 1 on days 1-28, and nivolumab IV over 30 minutes on days 1 and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Receives: Biological: Nivolumab; Drug: Sorafenib |
What is being measured
The primary outcome is the main question the study is designed to answer.
Maximum Tolerated Dose (MTD) (Part 1 Only)
MTD is defined as the dose in which 1 or more dose limiting toxicities (DLT) is reported by study participants in Part 1 within the first cycle of treatment. Participants in Part 1 must receive at least 2 doses of nivolumab and at least 75% of sorafenib doses within 28 days (1 cycle), or experience a qualifying DLT event to be evaluable.
Measured: 28 days
Proportion of Participants With Grade 3 or Higher Treatment-related Adverse Events (Part 2 Only)
All adverse event (AE) will be summarized based on proportion of total participants in Part 2 to evaluate the safety of the treatment combination in participants with Child-Pugh B7-9 liver function as measured by proportion of participants with an AE of toxicity grade >=3 as graded by NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 and assessed as at least possibly related to sorafenib, nivolumab, or the combination of therapies.
Measured: Up to 2 years
Secondary outcomes (14)
Proportion of Participants With Treatment-related Adverse Events
Overall rates of AE and serious adverse events (SAE) as classified by the NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 assessed as at least possibly related to sorafenib, nivolumab, or the combination of therapies will be reported as the proportion of participants in each arm.
.
Measured: Up to 2 years
Proportion of Participants Reporting Immune-related Adverse Event (irAE) (Part 1 and Part 2 Combined)
Safety events for all participants assessed by treating investigator and/or Study Chair as being at least possibly immune-related while on nivolumab (irAE) will be summarized based on proportion of total participants across all treatment groups combined.
Measured: Up to 2 years
Proportion of Participants With Child-Pugh B (CPB) Reporting Immune-related Adverse Event (irAE) (Parts 1 and 2 Combined)
Safety events for all CPB participants assessed by treating investigator and/or Study Chair as being at least possibly immune-related while on nivolumab (irAE) will be summarized based on proportion of total CPB participants across all treatment groups combined.
Measured: Up to 2 years
Proportion of Participants With Dose Delays Due to Toxicity
Delays in dosing due to adverse events will be summarized as proportion of participants by each arm.
Measured: Up to 2 years
Proportion of Participants With Dose Reductions Due to Toxicity
Dose reductions due to adverse events will be summarized as proportion of participants in each arm.
Measured: Up to 2 years
Proportion of Participants Who Discontinued Treatment Due to Toxicity
Treatment discontinuations due to adverse events will be summarized as proportion of participants in each arm.
Measured: Up to 2 years
Proportion of Participants With an Objective Response (Part 1 and Part 2 Combined)
Objective response is defined as the proportion of participants assessed using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 with measurable disease at study entry who have an evaluated complete response (CR) or partial response (PR) at any time during the main study. Participants with measurable disease at study entry who have unknown or missing response information will be treated as non-responders.
Measured: Up to 2 years
Proportion of Participants With an Objective Response by Part
Objective response will be based on assessments using RECIST 1.15 using local radiographic review and analyzed for Part 1 and Part 2 individually. Objective response is defined as the proportion of subjects with RECIST 1.1-measurable disease at study entry who have a CR or PR at any time during the main study. Participants with measurable disease at study entry who have unknown or missing response information will be treated as non-responders.
Measured: Up to 2 years
Median Duration of Response (DOR) (Part 1 and Part 2 Combined)
DOR is defined as the median time in months from first documented evidence of complete response (CR) or partial response (PR) as assessed by Response Evaluation Criteria in Solid Tumors (RECIST) until the first documented sign of disease progression or death for all participant who received any treatment during the course of the study.
Measured: Up to 2 years
Median Duration of Response (DOR) by Treatment Group
DOR is defined as the median time in months from first documented evidence of CR or PR assessed by Response Evaluation Criteria in Solid Tumors (RECIST) until the first documented sign of disease progression or death by treatment group for all participants who received treatment during the course of the study.
Measured: Up to 2 years
Median Progression-Free Survival (PFS) (Part 1 and Part 2 Combined)
PFS will be calculated as the median time in months from date of first dose of protocol therapy to date of first documented radiographic and/or clinical disease progression or death from any cause for all participants who received treatment during the course of the study. For participants who discontinued from study for other reasons than progression or death, PFS will be censored at the date last date known to be progression-free for up to 2 years following the last dose of protocol therapy.
Measured: Up to 3.5 years
Median Progression-free Survival (PFS) by Child-Pugh Group
PFS will be calculated as the median time in months from date of first dose of protocol therapy to date of first documented radiographic and/or clinical disease progression or death from any cause for participants grouped by Child-Pugh Group (Class A and Class B). For participants discontinued from study for other reasons than progression or death, PFS will be censored at the date last known to be progression-free for up to 2 years following the last dose of protocol therapy.
Measured: Up to 3.5 years
Median Overall Survival (OS) (Part 1 and Part 2 Combined)
OS is defined as the median time in months from the date of first dose of protocol therapy to the date of death due to any cause for up to 2 years following the last dose of protocol therapy. Censoring will be performed using the date of last known contact for those who are alive at the time of analysis. If data warrant, Kaplan-Meier estimates along with the 95% confidence intervals (CI) or full range will be reported.
Measured: Up to 3.5 years
Overall Survival (OS) by Child-Pugh Group
OS is defined as the median time in months from the date of first dose of protocol therapy to the date of death due to any cause for up to 2 years following the last dose of protocol therapy and will be reported for each of the Child-Pugh groups separately. Censoring will be performed using the date of last known contact for those who are alive at the time of analysis. If data warrant, Kaplan-Meier estimates along with the 95% confidence intervals (CI) or full range will be reported.
Measured: Up to 3.5 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted20 Feb 2018
- Study start16 Apr 2018
- Primary completion30 Nov 2023
- Study completion30 Nov 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Stage III Hepatocellular Carcinoma AJCC v8Studies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Masking
- None (open label)
- Enrolment
- 16 participants (actual)
Sponsor and investigators
- Lead sponsor
- Robin Kate Kelley
- Sponsor type
- University, hospital or other
- Collaborators
- Bayer, Bristol-Myers Squibb
- Responsible party
- Sponsor-investigator, Robin Kate Kelley, University of California, San Francisco
- Investigators
- Robin K. Kelley, MD, Principal investigator, University of California, San Francisco
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03439891
- Sponsor's protocol ID
- 174523
- Other IDs
- NCI-2018-00051
- Status last verified
- Jan 2025
- First submitted
- 13 Feb 2018
- Last updated
- 11 Feb 2025
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Keenan BP, Fan Z, Le BK, Harris Q, Chen J, Clark M, Lea A, Zhang L, Cheung A, Lara F, Gordan JD, Bracci P, Behr SC, Fong L, Venook AP, Kim EJ, Kelley RK. Phase II trial with nivolumab and sorafenib in HCC identified enrichment of immunosuppressive monocytes in patients with Child-Pugh B liver dysfunction. JHEP Rep. 2026 May;8(5):101817. doi: 10.1016/j.jhepr.2026.101817. Epub 2026 Mar 12.
PubMed 41831609
Study at a glance
From the registry record, last updated by the sponsor on 11 Feb 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Multicenter Pilot Study of the Safety, Efficacy, and Immune Cell Profiling in Advanced Hepatocellular Carcinoma (HCC) Patients Treated With the Combination of Sorafenib Plus Nivolumab as First-Line of Systemic Therapy
- ClinicalTrials.gov ID
- NCT03439891
- Acronym / sponsor ID
- 174523
- Conditions
- Stage III Hepatocellular Carcinoma AJCC v8, Stage IIIA Hepatocellular Carcinoma AJCC v8, Stage IIIB Hepatocellular Carcinoma AJCC v7, Stage IIIC Hepatocellular Carcinoma AJCC v7, Stage IV Hepatocellular Carcinoma AJCC v8, Stage IVA Hepatocellular Carcinoma AJCC v8
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 16 participants (actual)
- Lead sponsor
- Robin Kate KelleyUniversity, hospital or other
- Collaborators
- Bayer, Bristol-Myers Squibb
- Study start
- 16 Apr 2018 (actual)
- Primary completion
- 30 Nov 2023 (actual)
- Study completion
- 30 Nov 2023 (actual)
- First posted
- 20 Feb 2018 (actual)
- Results
- Posted 11 Feb 2025
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This phase II trial studies the best dose and side effects of sorafenib tosylate and nivolumab in treating patients with liver cancer that cannot be removed by surgery (unresectable), has spread to nearby tissues or lymph nodes (locally advanced) or to other places in the body (metastatic). Sorafenib tosylate may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Giving sorafenib tosylate and nivolumab may work better in treating patients with liver cancer.
Detailed description
PRIMARY OBJECTIVES:
- Maximum tolerated dose (MTD) of sorafenib tosylate (sorafenib) in combination with standard dose nivolumab with Child Pugh A-B7 liver function. (Part 1: Escalation Cohort).
II. Safety in participants with Child-Pugh B liver function. (Part 2: Child-Pugh B Escalation Cohort)
SECONDARY OBJECTIVES:
- Safety and tolerability of combination overall. (Parts 1 and 2).
II. Rate of immune-related adverse event (irAE) for combination overall and in participants with Child-Pugh B liver function. (Parts 1 and 2).
III. Overall response rate (ORR) by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 in participants with Child-Pugh B liver function. (Parts 1 and 2).
IV. Duration of response (DOR), progression free survival (PFS), and overall survival (OS) for escalation cohort and Child-Pugh B expansion cohort and overall. (Parts 1 and 2).
EXPLORATORY OBJECTIVES:
- Relationship between peripheral blood mononuclear cell (PBMC) immune cell subset frequencies, baseline liver function, and clinical outcomes.
II. Relationship between PBMC T cell receptor (TCR) clonotype frequency and diversity, baseline liver function, and clinical outcomes.
III. Tumor tissue immune cell subsets and TCR clonotype frequency and diversity in pre-treatment archival tumor tissue samples.
IV. Tumor and immune cell programmed death-ligand 1 (PD-L1) status in pre-treatment archival tumor tissue samples and relationship to clinical outcomes.
- Changes in hepatitis B virus (HBV) and/or hepatitis C virus (HCV) viral load on treatment.
VI. Alpha-fetoprotein (AFP) changes on treatment and relationship to clinical outcomes.
VII. Relationship between clinical outcomes and clinicopathologic features including race/ethnicity, etiology of liver disease including HBV/HCV status, baseline liver function, presence of cirrhosis, macrovessel invasion, extrahepatic spread, site(s) of metastatic disease, prior treatment history including prior radiation and arterial therapies.
OUTLINE: This is a dose-escalation and expansion study of sorafenib tosylate.
DOSE-ESCALATION (Part 1):
Between 3-12 participants will be enrolled in Part 1. Participants receive sorafenib tosylate orally (PO) once daily (QD) or twice daily (BID) on days 1-28, and nivolumab intravenously (IV) over 30 minutes on days 1 and 15. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
EXPANSION COHORT (Part 2).
Participants receive nivolumab IV over 30 minutes on days 1 and 15, and sorafenib tosylate once daily (QD) or twice daily (BID) on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, participants are followed up at 30 and 100 days, then every 3 months for up to 2 years after the last dose.
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Masking
- None (open label)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Part 1: Starting Dose Schedule (DL -1) Once a day | Experimental | Biological: Nivolumab, Drug: SorafenibParticipants with Child-Pugh A or B7 receive a daily dose of 400mg sorafenib on days 1-28, and 240mg of nivolumab IV over 30 minutes beginning on day 15 of course 1, then on days 1 and 15 of subsequent courses. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Course will continue until 1 dose-limiting toxicity occurs to establish maximum tolerated dosing schedule. |
| Part 1: Escalated Dose Schedule (DL 1) Twice a day | Experimental | Biological: Nivolumab, Drug: SorafenibParticipants with Child-Pugh A or B7 receive a daily dose of 400mg sorafenib twice a day on days 1-28, and 240mg of nivolumab IV over 30 minutes beginning on day 15 of course 1, then on days 1 and 15 of subsequent courses. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Course will continue until 1 dose-limiting toxicity occurs to establish maximum tolerated dosing schedule. |
| Part 2: Child-Pugh B (CPB) Expansion Cohort (sorafenib, nivolumab) | Experimental | Biological: Nivolumab, Drug: SorafenibParticipants with Child-Pugh B7-9 receive sorafenib at the maximum tolerated dose (MTD) established in Part 1 on days 1-28, and nivolumab IV over 30 minutes on days 1 and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (30 listed)
- Histologic or cytologic diagnosis of unresectable, locally advanced and/or metastatic hepatocellular carcinoma (HCC) not amenable to curative surgery, transplantation, or ablative therapies based upon assessment of treating investigator.
- Radiographically measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 in at least one site not previously treated with chemoembolization, radioembolization, radiation, or other local/liver-directed procedures (i.e. must have at least one measurable target lesion, either within the liver or in a measurable metastatic site); a new area of tumor progression within or adjacent to a previously-treated lesion, if clearly measurable by a radiologist, is acceptable.
- Untreated/pretreatment archival tumor tissue must be available for correlative analyses
- Age at least 18 years at enrollment.
- Eastern Cooperative Oncology Group (ECOG) 0 or 1 at enrollment
Key exclusion criteria (43 listed)
- Any prior systemic therapy for HCC.
- Known fibrolamellar or mixed HCC-cholangiocarcinoma histology.
- Requirement for paracentesis to control ascites within 6 months before enrollment.
- Symptomatic hepatic encephalopathy requiring medication (such as lactulose or rifaximin) (Part 1) or any hospitalization for encephalopathy within 6 months before enrollment (Part 1 or 2).
- History of upper gastrointestinal (GI) bleeding from esophageal and/or gastric varices within 12 months before enrollment.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| NivolumabAlso: BMS-936558, MDX-1106, NIVO, ONO-4538Given IV | Biological | Part 1: Escalated Dose Schedule (DL 1) Twice a day, Part 1: Starting Dose Schedule (DL -1) Once a day, Part 2: Child-Pugh B (CPB) Expansion Cohort (sorafenib, nivolumab) |
| SorafenibAlso: BAY 43-9006Given PO | Drug | Part 1: Escalated Dose Schedule (DL 1) Twice a day, Part 1: Starting Dose Schedule (DL -1) Once a day, Part 2: Child-Pugh B (CPB) Expansion Cohort (sorafenib, nivolumab) |
Primary outcome
Maximum Tolerated Dose (MTD) (Part 1 Only)
Time frame: 28 days
MTD is defined as the dose in which 1 or more dose limiting toxicities (DLT) is reported by study participants in Part 1 within the first cycle of treatment. Participants in Part 1 must receive at least 2 doses of nivolumab and at least 75% of sorafenib doses within 28 days (1 cycle), or experience a qualifying DLT event to be evaluable.
Proportion of Participants With Grade 3 or Higher Treatment-related Adverse Events (Part 2 Only)
Time frame: Up to 2 years
All adverse event (AE) will be summarized based on proportion of total participants in Part 2 to evaluate the safety of the treatment combination in participants with Child-Pugh B7-9 liver function as measured by proportion of participants with an AE of toxicity grade >=3 as graded by NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 and assessed as at least possibly related to sorafenib, nivolumab, or the combination of therapies.
14 secondary outcomes
Proportion of Participants With Treatment-related Adverse Events
Time frame: Up to 2 years
Proportion of Participants Reporting Immune-related Adverse Event (irAE) (Part 1 and Part 2 Combined)
Time frame: Up to 2 years
Proportion of Participants With Child-Pugh B (CPB) Reporting Immune-related Adverse Event (irAE) (Parts 1 and 2 Combined)
Time frame: Up to 2 years
Proportion of Participants With Dose Delays Due to Toxicity
Time frame: Up to 2 years
Proportion of Participants With Dose Reductions Due to Toxicity
Time frame: Up to 2 years
Proportion of Participants Who Discontinued Treatment Due to Toxicity
Time frame: Up to 2 years
Proportion of Participants With an Objective Response (Part 1 and Part 2 Combined)
Time frame: Up to 2 years
Proportion of Participants With an Objective Response by Part
Time frame: Up to 2 years
Median Duration of Response (DOR) (Part 1 and Part 2 Combined)
Time frame: Up to 2 years
Median Duration of Response (DOR) by Treatment Group
Time frame: Up to 2 years
Median Progression-Free Survival (PFS) (Part 1 and Part 2 Combined)
Time frame: Up to 3.5 years
Median Progression-free Survival (PFS) by Child-Pugh Group
Time frame: Up to 3.5 years
Median Overall Survival (OS) (Part 1 and Part 2 Combined)
Time frame: Up to 3.5 years
Overall Survival (OS) by Child-Pugh Group
Time frame: Up to 3.5 years
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Feb 2025.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Derived from this study: PubMed 41831609Keenan BP, Fan Z, Le BK, Harris Q, Chen J, Clark M, Lea A, Zhang L, Cheung A, Lara F, Gordan JD, Bracci P, Behr SC, Fong L, Venook AP, Kim EJ, Kelley RK. Phase II trial with nivolumab and sorafenib in HCC identified enrichment of immunosuppressive monocytes in patients with Child-Pugh B liver dysfunction. JHEP Rep. 2026 May;8(5):101817. doi: 10.1016/j.jhepr.2026.101817. Epub 2026 Mar 12.
- Individual participant dataSharing planned: No
Related trials for Stage III Hepatocellular Carcinoma AJCC v8
Active, not recruitingPhase 1/2
Nivolumab, Fluorouracil, and Interferon Alpha 2B for the Treatment of Unresectable Fibrolamellar Cancer
Stage III Hepatocellular Carcinoma AJCC v8, Stage IIIA Hepatocellular Carcinoma AJCC v8
RecruitingPhase 1/2
Testing the Addition of an Anti-cancer Drug, Sapanisertib, to the Usual Chemotherapy Treatment (Cabozantinib) in Metastatic Liver Cell Cancer With a Change in Genes for the Protein β-Catenin, The SAPHIRE Trial
Advanced Hepatocellular Carcinoma, Metastatic Hepatocellular Carcinoma
Active, not recruitingPhase 2
Testing the Combination of Pevonedistat With Chemotherapy for Bile Duct Cancer of the Liver
Metastatic Cholangiocarcinoma, Metastatic Hepatocellular Carcinoma
RecruitingPhase 1/2
Zanzalintinib in Second Line and Beyond for the Treatment of Advanced Liver Cancer
Advanced Hepatocellular Carcinoma, Cirrhosis
RecruitingPhase 4
Morning Versus Afternoon Administration of Immunotherapy for the Treatment of Advanced or Metastatic Solid Tumors, The Knight SHIFT Study
Advanced Biliary Tract Carcinoma, Advanced Head and Neck Squamous Cell Carcinoma
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Robin K. Kelley, MD principal investigator
University of California, San Francisco
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Nivolumab and Sorafenib in people with Stage III Hepatocellular Carcinoma AJCC v8 and Stage IIIA Hepatocellular Carcinoma AJCC v8, run by Robin Kate Kelley at 2 sites in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 30 inclusion and 43 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 11 Feb 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 11 Feb 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Maximum Tolerated Dose (MTD) (Part 1 Only) (time frame: 28 days). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03439891, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Feb 2025.