Recruitment Begins For Multi-modality Trial to Help Develop Immunotherapy Treatment for Liver Cancer


Key points:

  • Study by four major medical institutions, led by NCCS
  • First in the world to combine immunotherapy, Nivolumab with Y90 SIR-Spheres radioembolisation in liver cancer
  • Promising efficacy of either modality alone may be further enhanced when combined together


National Cancer Centre Singapore (NCCS), Singapore General Hospital (SGH), Genome Institute of Singapore (GIS), and Singapore Immunology Network (SIgN) are collaborating to carry out a multi-modality clinical trial which may lead to the development of a new treatment strategy for liver cancer.

Liver Cancer (HCC) is the second most common cause of cancer mortality in Southeast Asia and more than 70% cases of HCC in Southeast Asia are a consequence of chronic infection with Hepatitis B Virus (HBV).

The investigator-initiated Phase 2 trial will be studying the combination of two treatments, Yittrium-90 (Y90) SIR-Spheres microspheres radioembolisation and Nivolumab.

Y90 radioembolisation is currently used for liver cancer patients who are unsuitable for surgery or liver transplantation. Nivolumab, an immunotherapy drug that enhances the body’s immune response against cancer cells, is showing very promising results for advanced liver cancer patients in ongoing studies. Nivolumab has also been shown to enhance the effects of radiation in various cancers. When combined with radiation, nivolumab have been observed to cause an abscopal effect, where localised treatment of a tumour not only shrinks the treated tumour, but also tumours in other parts of the body that are not irradiated.

The aim of this trial is to show that nivolumab can enhance the effects of radioembolisation in liver cancer and further improve outcomes for patients.

This approach is the first in the world and is supported by Singapore Ministry of Health’s National Medical Research Council, Bristol-Myers Squibb and Sirtex.

Currently, the treatment for liver cancer (HCC) patients diagnosed with intermediate stage disease includes liver surgery, transarterial chemoembolisation or radioembolisation. The average survival of intermediate HCC patients treated with Y90 radioembolisation is 15 to 18 months. As therapy options for advanced HCC are very limited, there is an urgent need to provide treatments to improve patient survival rates.

“Nivolumab has shown some initial promising activity in advanced liver cancer and studies are ongoing. Therefore there is a rationale to conduct this study in earlier stages of liver cancer. Y90 radioembolisation is often used to treat liver cancer. SGH and NCCS have extensive experience with this modality of treatment. We plan to study whether nivolumab may help to further enhance the efficacy of radioembolisation. If proven so, this will change the way we treat liver cancers.” said Dr Choo Su Pin, a Senior Consultant Medical Oncologist with National Cancer Centre Singapore (NCCS), and Adjunct Associate Professor, Oncology Academic Clinical Programme with Duke-NUS Medical School. She is also the Lead Principal Investigator of this study. 

The trial, which started since December 2016, is planned to be completed in two years. Patients who have un-resectable liver cancer and are eligible for radioembolisation will be offered participation in the study.

40 patients will be recruited at the NCCS. Patients will first be administered the Y90 radioembolisation at SGH. Nivolumab will be given through an intravenous (IV) infusion 21 days later, and every 2 weeks thereafter. Besides evaluating the response rates of the combined treatments, the team aims to assess its progression-free survival and overall survival, quality of life and safety and tolerability.

Those who wish to participate in this study may contact the NCCS Clinical Trial Office at

Source: NCCS