Concurrent Nivolumab and External Beam Radiation Therapy for Patients With Advanced HCC

<Treatment phase> Nivolumab 3mg/kg IV is administered as 30-minute IV infusion every 2 weeks. External beam radiotherapy begins 2-7 days after the first dose of nivolumab. The study drug is continued until disease progression, unacceptable toxicity, withdrawal of consent or study closure.

<Follow-Up phase > After the treatment phase, subjects will undergo follow up for survival every 12 weeks (± 7 days) from the last dose or the use of other anticancer treatments and/or therapies, and the survival follow up will be performed for at least 18 months after the enrollment of the last subject. The patient will be followed for survival follow up and the use of other anticancer treatments and/or therapies.

Based on the assumed dropout rate of 12%, a total of 50 subjects need to perform the study (50=44/(1-0.12))

Inclusion criteria

• Patients with HCC meeting all of following criteria;

• Signed written informed consent
• Age >= 20
• Histological or clinical diagnosis of HCC based on the guidelines of the Korean Liver Cancer Association-National Cancer Center17
• Having at least one typical enhanced measurable index lesion (in the liver) by dynamic CT or dynamic contrast-enhanced MRI
• Presence of major vascular invasion on dynamic CT or dynamic MRI

① an intraluminal filling defect adjacent to the primary tumor in portal vein, hepatic vein, and/or inferior vena cava

② an enhancement of the filling defect on arterial phase and a washout on portal/delayed phases.

• Sorafenib naïve or sorafenib experienced
• Child-Pugh class A
• Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0-1
• Life expectancy of at least 16 weeks
• Adequate hematologic and hepatic function (should be obtained within 14 days prior to screening:

• Hemoglobin ≥ 9.0 g/dL

• Absolute neutrophil count (ANC) ≥ 1,000/mm3 ③ Platelet count ≥ 50,000/μL

• Total bilirubin < 2.5 mg/dL

• Serum albumin >2.8 g/dL ⑥ Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 5 × upper limit of normal (ULN) ⑦ Prothrombin time in INR ≤ 1.8 × ULN ⑧ Serum creatinine ≤ 1.5 mg/dL
• Women of childbearing potential and men must agree to use highly efficient contraception since signing of the IC form until at least 5 months (women) and 7 months (men) after the last study drug administration.

Exclusion criteria

• Patients with HCC meeting all of following criteria;

• Receipt of 2 or more prior systemic therapies for advanced HCC. Additional prior systemic therapies used as adjuvant or local therapy are allowed.
• Any type of anticancer agent (including investigational) within 2 weeks before enrollment
• Having active brain metastasis or leptomeningeal metastasis
• Moderate to severe or intractable ascites
• A history or presence of hepatic encephalopathy
• Presence of active bacterial infection
• Untreated active chronic hepatitis B
• History of portal hypertension with bleeding within the past 6 months
• Prior liver transplant
• Uncontrolled severe medical comorbidity
• Other malignant disease (a history of treated malignancy -other than HCC- is allowable if the patient's malignancy has been in complete remission, off chemotherapy and without additional surgical intervention, during the preceding two years)
• Current or past history of hypersensitivity to nivolumab