Based on the Phase 3 CheckMate-9DW trial, Opdivo plus Yervoy demonstrated a statistically significant overall survival benefit compared to investigator’s choice of lenvatinib or sorafenib1
In the trial, 38% of patients were still alive at 3 years with this dual immunotherapy vs. 24% with the comparator arm1
PRINCETON, NJ, USA I April 11, 2025 I Bristol Myers Squibb (NYSE: BMY) today announced that the U.S. Food and Drug Administration (FDA) approved Opdivo®(nivolumab) plus Yervoy® (ipilimumab) as a first-line treatment for adult patients with unresectable or metastatic hepatocellular carcinoma (HCC), the most common primary liver cancer.1,2 This approval is based on the results from the global Phase 3 randomized, open-label CheckMate-9DW trial evaluating the combination of Opdivo plus Yervoy compared to investigator’s choice of tyrosine kinase inhibitor monotherapy (lenvatinib or sorafenib) in patients with unresectable or metastatic HCC who have not received prior systemic therapy.1 In the trial, Opdivo plus Yervoy demonstrated statistically significant overall survival (OS) and overall response rate (ORR) vs the comparator arm.1 It is the only trial supporting an FDA approval to show superior results against this comparator arm.1
MEDIA: @US_FDA approves first-line immunotherapy treatment option for certain patients with hepatocellular carcinoma.
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“The CheckMate-9DW approval is an important advancement for patients, considering the incidence of liver cancer has tripled in the last four decades, yet prognosis for HCC patients remains poor,” said Aiwu Ruth He, MD, PhD, a CheckMate-9DW study investigator while at MedStar Georgetown University Hospital.3,4 “The availability of a new first-line treatment option that demonstrated a deep response can offer adults with this form of liver cancer long-term overall survival and may help address an unmet need.1,5,6 Given the strength of evidence from the trial, especially considering the selection and performance of a strong comparator arm, I believe that Opdivo plus Yervoy has the potential to become a standard of care for the first-line treatment of patients with unresectable or metastatic HCC.”1
In the CheckMate-9DW trial, in which 85% of patients in the comparator arm were treated with lenvatinib and 15% were treated with sorafenib, mOS with Opdivo plus Yervoy (n=335) was 23.7 months (95% CI: 18.8-29.4) vs. 20.6 months (95% CI: 17.5-22.5) with lenvatinib or sorafenib (n=333; HR=0.79; 95% CI: 0.65-0.96 P=0.0180), reducing the risk of death by 21%.1 Opdivo plus Yervoy showed an OS rate of 38% at three years vs. 24% with lenvatinib or sorafenib monotherapy.1 The trial also showed a deeper response with Opdivo plus Yervoy, demonstrating an ORR of 36.1% (95% CI: 31-41.5) compared to 13.2% (95% CI: 9.8-17.3; P<0.0001) of patients treated with lenvatinib or sorafenib (complete response 6.9% vs 1.8%; partial response 29.3% vs 11.4%).1 Longer responses were seen with Opdivo plus Yervoy with a median duration of response (mDOR) of 30.4 months (95% CI: 21.2-NR) and 12.9 months (95% CI: 10.2-31.2) with lenvatinib or sorafenib.1 DOR is not included in the statistical hierarchical testing and therefore is not a powered endpoint.1 The safety profile with Opdivo plus Yervoy is well-established and there were no new safety signals identified.5
Opdivo plus Yervoy is associated with the following Warnings and Precautions: severe and fatal immune-mediated adverse reactions including pneumonitis, colitis, hepatitis and hepatotoxicity, endocrinopathies, nephritis with renal dysfunction, dermatologic adverse reactions, other immune-mediated adverse reactions; infusion-related reactions; complications of allogeneic hematopoietic stem cell transplantation (HSCT); embryo-fetal toxicity; and increased mortality in patients with multiple myeloma when Opdivo is added to a thalidomide analogue and dexamethasone, which is not recommended outside of controlled clinical trials.1 Please see the Important Safety Information section below.
“Bringing Opdivo plus Yervoy to patients with HCC in the first-line setting is a testament to our ongoing commitment to research and delivering important progress for people living with cancer,” said Wendy Short Bartie, senior vice president of Oncology Commercialization at Bristol Myers Squibb. “Today’s approval builds on the legacy of our dual immunotherapy and the value it has brought to patients for years.1 We are thrilled to add this indication for this important therapy – our second approval for Opdivo plus Yervoy in the gastrointestinal space this week alone – and look forward to providing a new first-line treatment option to patients in need.”1
The combination of Opdivo plus Yervoy was previously granted accelerated approval by the U.S. FDA in 2020 based on results from the Phase 1/2 CheckMate-040 trial and has been an established second-line treatment for patients with advanced HCC who were previously treated with sorafenib.1 Today’s FDA decision converts this existing indication to full approval and expands the indication into the first-line setting based on the results from the CheckMate-9DW trial.1
About CheckMate-9DW
CheckMate-9DW is a Phase 3 randomized, open-label trial evaluating the combination of Opdivo® (nivolumab) plus Yervoy® (ipilimumab) compared to investigator’s choice of lenvatinib or sorafenib monotherapy in patients with unresectable or advanced hepatocellular carcinoma (HCC) who have not received prior systemic therapy.7 In the trial, 668 patients were randomized to receive Opdivo plus Yervoy IV infusion (Opdivo 1mg/kg with Yervoy 3mg/kg every three weeks for up to four doses, followed by Opdivo monotherapy 480mg every four weeks until disease progression, unacceptable toxicity or for a maximum duration of two years), or single agent lenvatinib (8mg orally daily, if body weight <60kg, or 12mg orally daily, if body weight ≥60kg) or sorafenib (400mg orally twice daily) in the control arm.1,5 The primary endpoint of the trial is overall survival and key secondary endpoints include objective response rate and time to symptom deterioration.1 The study was not designed to independently compare Opdivo plus Yervoy vs. lenvatinib or Opdivo plus Yervoy vs. sorafenib.1
Select Safety Profile from CheckMate-9DW
The safety analysis in CheckMate-9DW included 657 patients, of whom 332 received Opdivo plus Yervoy.1 Serious adverse reactions occurred in 53% of patients treated with Opdivo plus Yervoy.1 The most frequent non liver-related serious adverse reactions reported in ≥2% of patients who received Opdivo with Yervoy were diarrhea/colitis (4.5%), gastrointestinal hemorrhage (3%), and rash (2.4%). Liver-related serious adverse reactions occurred in 17% of patients treated with Opdivo in combination with Yervoy, including Grade 3-4 events in 16% of patients. The most frequently reported all grade liver-related serious adverse reactions occurring in ≥1% of patients who received Opdivo in combination with Yervoy were immune-mediated hepatitis (3%), increased AST/ALT (3%), hepatic failure (2.4%), ascites (2.4%), and hepatotoxicity (1.2%).1 The most common adverse reactions reported in >20% of patients treated with Opdivo plus Yervoy were rash, pruritus, fatigue, and diarrhea. Fatal adverse reactions occurred in 12 (3.6%) patients who received Opdivo plus Yervoy; these included 4 (1.2%) patients who died due to immune-mediated or autoimmune hepatitis and 4 (1.2%) patients who died of hepatic failure.1 Permanent discontinuation due to an adverse reaction occurred in 27% of patients treated with Opdivo in combination with Yervoy. Adverse reactions leading to permanent discontinuation in >1% of patients included immune-mediated hepatitis (1.8%), diarrhea/colitis (1.8%), and hepatic failure (1.2%).1
About Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) is a type of primary liver cancer and is the most common form of liver cancer in adults.2 Liver cancer is the sixth leading cause of cancer deaths in the United States.8 HCC is often diagnosed at an advanced stage and is usually associated with poor prognosis with limited effective treatment options.5,9,10 About 42,240 people in the United Stated will be diagnosed and about 30,090 people will die of liver cancer in 2025.3 The incidence rates of liver cancer have tripled in the U.S. since 1980 and deaths have doubled since then.3 HCC typically develops in patients with hepatitis virus infection or cirrhosis.11 While most cases of HCC are caused by hepatitis B virus or hepatitis C virus infections, metabolic syndrome and metabolic dysfunction-associated steatohepatitis are rising in prevalence and expected to contribute to increased rates of HCC.11
INDICATIONS
OPDIVO® (nivolumab), in combination with YERVOY® (ipilimumab), is indicated for the first-line treatment of adult patients with unresectable or metastatic hepatocellular carcinoma (HCC).
OPDIVO® (nivolumab), in combination with YERVOY® (ipilimumab), is indicated for the treatment of adult patients with unresectable or metastatic hepatocellular carcinoma (HCC) who have been previously treated with sorafenib.
Please see U.S. Full Prescribing Information for OPDIVO and YERVOY.
Clinical Trials and Patient Populations
CheckMate-9DW – hepatocellular carcinoma, in combination with YERVOY; CheckMate-040 – hepatocellular carcinoma, in combination with YERVOY, after prior treatment with sorafenib.
Bristol Myers Squibb: Creating a Better Future for People with Cancer
Bristol Myers Squibb is inspired by a single vision — transforming patients’ lives through science. The goal of the company’s cancer research is to deliver medicines that offer each patient a better, healthier life and to make cure a possibility. Building on a legacy across a broad range of cancers that have changed survival expectations for many, Bristol Myers Squibb researchers are exploring new frontiers in personalized medicine and, through innovative digital platforms, are turning data into insights that sharpen their focus. Deep understanding of causal human biology, cutting-edge capabilities and differentiated research platforms uniquely position the company to approach cancer from every angle.
Cancer can have a relentless grasp on many parts of a patient’s life, and Bristol Myers Squibb is committed to taking actions to address all aspects of care, from diagnosis to survivorship. As a leader in cancer care, Bristol Myers Squibb is working to empower all people with cancer to have a better future.
About Bristol Myers Squibb’s Patient Access Support
Bristol Myers Squibb remains committed to providing assistance so that cancer patients who need our medicines can access them and expedite time to therapy.
BMS Access Support®, the Bristol Myers Squibb patient access and reimbursement program, is designed to help appropriate patients initiate and maintain access to BMS medicines during their treatment journey. BMS Access Support offers benefit investigation, prior authorization assistance, as well as co-pay assistance for eligible, commercially insured patients. More information about our access and reimbursement support can be obtained by calling BMS Access Supportat 1-800-861-0048 or by visiting www.bmsaccesssupport.com.
About the Bristol Myers Squibb and Ono Pharmaceutical Collaboration
In 2011, through a collaboration agreement with Ono Pharmaceutical Co., Bristol Myers Squibb expanded its territorial rights to develop and commercialize Opdivo globally, except in Japan, South Korea and Taiwan, where Ono had retained all rights to the compound at the time. On July 23, 2014, Ono and Bristol Myers Squibb further expanded the companies’ strategic collaboration agreement to jointly develop and commercialize multiple immunotherapies – as single agents and combination regimens – for patients with cancer in Japan, South Korea and Taiwan.
About Bristol Myers Squibb
Bristol Myers Squibb is a global biopharmaceutical company whose mission is to discover, develop and deliver innovative medicines that help patients prevail over serious diseases. For more information about Bristol Myers Squibb, visit us at BMS.com or follow us on LinkedIn, X, YouTube, Facebook and Instagram.
References
- Opdivo Prescribing Information. Opdivo U.S. Product Information. Last updated: April 2025. Princeton, NJ: Bristol Myers Squibb Company.
- American Cancer Society. What is Liver Cancer? Available at https://www.cancer.org/cancer/types/liver-cancer/about/what-is-liver-cancer.html. Accessed February 21, 2025.
- American Cancer Society. Key Statistics About Liver Cancer. Available at https://www.cancer.org/cancer/types/liver-cancer/about/what-is-key-statistics.html. Accessed February 21, 2025.
- American Cancer Society. Liver Cancer Survival Rates. Available at https://www.cancer.org/cancer/types/liver-cancer/detection-diagnosis-staging/survival-rates.html. Accessed February 21, 2025.
- Galle et al. Nivolumab (NIVO) plus ipilimumab (IPI) vs lenvatinib (LEN) or sorafenib (SOR) as first-line treatment for unresectable hepatocellular carcinoma (uHCC): First results from CheckMate 9DW. Journal of Clinical Oncology. 42, LBA4008-LBA4008(2024).
- Finn et al. Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma. N Engl J Med. 2020;382:1894-1905.
- ClinicalTrials.gov: NCT04039607. A Study of Nivolumab in Combination With Ipilimumab in Participants With Advanced Hepatocellular Carcinoma. Available at https://clinicaltrials.gov/study/NCT04039607. Accessed February 21, 2025.
- American Cancer Society. Cancer Facts and Figures 2025. Available at https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2025/2025-cancer-facts-and-figures-acs.pdf. Accessed February 21, 2025.
- Abou-Alfa et al. Tremelimumab plus Durvalumab in Unresectable Hepatocellular Carcinoma. N Engl J Med Evid. 2022;1(8).
- American Cancer Association. Can Liver Cancer Be Found Early? Available at https://www.cancer.org/cancer/types/liver-cancer/detection-diagnosis-staging/detection.html. Accessed February 21, 2025.
- American Cancer Society. Liver Cancer Risk Factors. Available at https://www.cancer.org/content/dam/CRC/PDF/Public/8699.00.pdf. Accessed February 21, 2025.
SOURCE: Bristol Myers Squibb