The PRIME-HCC trial will assess the effects of combination treatment with nivolumab (OPDIVO) and ipilimumab (YERVOY) pre-operatively in hepatocellular carcinoma patients for whom liver resection is planned. The trial will be conducted at a small number of National Health Service hospitals in the UK. Participants will receive two doses of nivolumab and a single dose of ipilimumab in the weeks before their planned surgery.
This is a single-arm, open-label study to be conducted in 32 patients at a small number of UK hospitals. The study is in 2 parts: Part 1 will confirm, in a small number of patients, that the treatment regimen is safe and doesn't result in unacceptable delay to liver resection. Part 2 will expand the number of patients studied, and provide the opportunity to assess survival over about 2 years after liver resection. The decision to proceed to Part 2 will be taken with advice from an independent, expert committee. Patients with early-stage HCC will first undergo screening procedures during a 28-day time window between giving consent and starting drug treatment. Screening procedures will include: * Medical interview and physical exam * ECG * Tumour biopsy * Tumour imaging by MRI * Tumour imaging by CT * Blood and urine samples * Stool sample (optional) Patients meeting the protocol-specified criteria will be enrolled and on Day 1 will have the following: * Medical interview, and physical exam (if required) * Blood and urine samples * Intravenous dose of ipilimumab ('YERVOY') 1 milligram per kilogram body weight * Intravenous dose of nivolumab ('OPDIVO') 3 milligrams per kilogram body weight On Day 22 the participants will have the following: * Medical interview, and physical exam (if required) * Blood and urine samples * Intravenous dose of nivolumab ('OPDIVO') 3 milligrams per kilogram body weight On Day 43 the participants will have the following: * Medical interview, and physical exam (if required) * ECG * Tumour imaging by MRI * Blood and urine samples * Stool sample (optional) Patients who remain eligible for liver resection will likely undergo surgery within a few days of the Day 43 visit. On Day 127 the participants will have the following: * Medical interview, and physical exam (if required) * Tumour imaging by MRI * Blood and urine samples Every 4 months thereafter until 2 years later, or until starting another anti-cancer treatment, participants will have tumour imaging by MRI.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
33
Ipilimumab is a monoclonal antibody given as an immunotherapy
Nivolumab is a monoclonal antibody given as an immunotherapy
Imperial College Healthcare NHS Trust
London, Greater London, United Kingdom
Delay to Surgery
Number of patients with an unplanned delay to surgery to Day 89 or later
Time frame: Up to Day 89
Frequency of Treatment-related Adverse Events [Safety and Tolerability]
Safety and tolerability of the nivolumab and ipilimumab combination based on NCI CTCAE v5.0 criteria from the day of first nivolumab and ipilimumab administration to 126 days later. Treatment-related adverse events (TRAE) are defined as any unfavorable medical occurrence, symptom, or abnormal laboratory finding in a participant that is deemed to be either definitely, probably, or possibly caused by the trial treatment.
Time frame: Up to Day 127
Objective Response Rate
Objective response rate (complete or partial response) on pre-resection imaging 42 days after the day of first nivolumab and ipilimumab administration using Response Evaluation Criteria in Solid Tumours (RECIST) criteria v1.1. The criteria classifies response based on the assessment of target and non-target lesions on scans as: Complete Response (CR): requires all of: * disappearance of all target and non-target lesions * pathological lymph nodes must have reduced to \<10 mm in short axis * no new lesions Partial Response (PR): requires all of: * at least 30% decrease in sum of diameters (SOD) of target lesions compared to baseline sum diameters * non-progressive disease of non-target lesions * no new lesions Progressive Disease (PD): either one of: * any new lesions * at least 20% relative and 5 mm absolute increase of SOD of target lesions compared to smallest SOD ever recorded for the patient Stable Disease (SD): not meeting criteria for PD or PR.
Time frame: Up to Day 43
Pathologic Response Rate
Pathologic response rate (≥70%) on hematoxylin and eosin evaluation of the resected specimen.
Time frame: Up to Day 88 or up to liver resection, whichever came first
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.