- 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
Singapore, 26 January 2017 - Four major medical institutions are collaborating to carry out a multi-modality clinical trial which may lead to the development of a new treatment strategy for liver cancer.
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. Furthermore, immunotherapy drugs like nivolumab when combined with radiation 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.
Thus, 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 under its Clinician Scientist-Individual Research Grant (NMRCCIRG/1454/2016), Bristol-Myers Squibb and Sirtex.
“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.
Besides Dr Choo, the other Co-Investigators involved include Dr David Tai, Consultant
Medical Oncologist, NCCS, who is also an Adjunct Associate Professor, Oncology
Academic Clinical Programme with Duke-NUS Medical School, Adjunct Associate
Professor David Ng, Head and Senior Consultant, Department of Nuclear Medicine & PET,
Singapore General Hospital (SGH), Dr Apoorva Gogna, Consultant, Department of
Diagnostic Radiology, SGH, Dr Zhai Weiwei, Senior Research Scientist, Human Genetics,
Genome Institute of Singapore, and Adjunct Assistant Professor Evan Newell, Principal
Investigator, Singapore Immunology Network.
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
Those who wish to participate in this study may contact the NCCS Clinical Trial Office at
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).
Currently, the treatment for 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. In advanced cases, oral sorafenib may be administered to prolong survival of
patients by about 2.5 months over best supportive care. As therapy options for advanced
HCC are very limited, there is an urgent need to provide treatments to improve patient
About National Cancer Centre Singapore
National Cancer Centre Singapore (NCCS) provides a holistic and multi-disciplinary
approach to cancer treatment and patient care. We treat almost 70 per cent of the public
sector oncology cases, and they are benefiting from the sub-specialisation of our clinical
oncologists. NCCS is also accredited by the US-based Joint Commission International for
its quality patient care and safety. To deliver among the best in cancer treatment and care,
our clinicians work closely with our scientists who conduct robust cutting-edge clinical and
translational research programmes which are internationally recognised. NCCS strives to
be a global leading cancer centre, and shares its expertise and knowledge by offering
training to local and overseas medical professionals. www.nccs.com.sg
For more information, please contact:
National Cancer Centre Singapore
Senior Executive, Corporate Communications
Tel: +65 6236 9429