Drugs, Health Technologies, Health Systems

Reimbursement Recommendation

Nivolumab Plus Ipilimumab (Opdivo Plus Yervoy)

Indication: Opdivo (nivolumab), in combination with ipilimumab, for the first-line treatment of adult patients with unresectable or advanced hepatocellular carcinoma

Sponsor: Bristol Myers Squibb Canada Co.

Recommendation: Reimburse with conditions

Summary

What Is the Reimbursement Recommendation for Opdivo Plus Yervoy?

Canada’s Drug Agency (CDA-AMC) recommends that Opdivo plus Yervoy be reimbursed by public drug plans for the first-line treatment of adult patients with unresectable or advanced hepatocellular carcinoma (HCC) if certain conditions are met.

Why Did CDA-AMC Recommend Reimbursement?

The pan-Canadian Oncology Drug Review Expert Review Committee (pERC) determined that Opdivo plus Yervoy demonstrates acceptable clinical value versus tyrosine kinase inhibitors (TKIs) (sorafenib and lenvatinib), and immunotherapies (atezolizumab plus bevacizumab, and durvalumab plus tremelimumab) in adults with HCC at an advanced stage when it can no longer be surgically removed (unresectable or advanced). This determination was enough for pERC to recommend that Opdivo plus Yervoy be reimbursed.

Given that Opdivo plus Yervoy is expected to be an alternative to TKIs or currently available immunotherapies, acceptable clinical value refers to at least comparable value versus TKIs and immunotherapies. Evidence from a clinical trial (CheckMate 9DW) showed that treatment with Opdivo plus Yervoy likely results in patients living longer (improved overall survival [OS]) compared with sorafenib and lenvatinib at 24 months in patients with unresectable or advanced HCC. Evidence from an indirect treatment comparison suggested better OS with Opdivo plus Yervoy compared to other immunotherapies (atezolizumab plus bevacizumab, and durvalumab plus tremelimumab) after 6 months in adults with unresectable or advanced HCC.

Opdivo plus Yervoy was considered an alternative immunotherapy option that may offer a clinical benefit for some patients beyond 6 months of treatment. A key limitation of the evidence is the absence of information identifying which patients are at a higher risk of death in the first 6 months of treatment.

Which Patients Are Eligible for Coverage?

Opdivo plus Yervoy should only be covered for the first-line treatment of adults with unresectable or advanced HCC who have Child-Pugh score class A and good performance status. Opdivo plus Yervoy should not be covered if the patient has been previously treated for unresectable or advanced HCC.

What Are the Conditions for Reimbursement?

Opdivo plus Yervoy should be prescribed by and managed under the care of clinicians with expertise in managing unresectable or advanced HCC. Reimbursement should be for a maximum of 2 years of treatment. Reimbursement should be discontinued if the cancer becomes worse or there are unacceptable side effects. The total treatment cost of Opdivo plus Yervoy should not exceed that of treatment with the least costly immunotherapy comparator.

Important economic feasibility must be addressed for health systems to be able to adopt Opdivo plus Yervoy due to the magnitude of uncertainty in the budget impact.

Review Background

Highlights of Input From Interested Parties

The patient groups (Liver Canada, The Canadian Cancer Survivor Network, Cholangio-Hepatocellular Carcinoma Canada, and the Colorectal Cancer Resource & Action Network) noted the following regarding impacts of the disease, unmet needs, and important outcomes:

The clinician groups (the Canadian Gastrointestinal Oncology Evidence Network and Ontario Health [Cancer Care Ontario] Gastrointestinal Cancer Drug Advisory Committee) and the clinical experts consulted by CDA-AMC noted the following regarding unmet needs arising from the disease and place in therapy for the drug under review:

The participating public drug programs raised potential implementation issues related to considerations for initiation, renewal, discontinuation, and prescribing of therapy; generalizability of trial populations to broader populations; care provision issues; system and economic issues; and potential need for a provisional funding algorithm.

Recommendation

With a vote of 10 in favour to 6 against, pERC recommends that nivolumab plus ipilimumab be reimbursed for the first-line treatment of adult patients with unresectable or advanced hepatocellular carcinoma only if the conditions listed in Table 1 are met.

Table 1: Reimbursement Conditions and Reasons

Reimbursement condition

Reason

Implementation guidance

Initiation

1. Nivolumab in combination with ipilimumab should be reimbursed for the first-line treatment of adult patients with unresectable or advanced HCC who meet all the following criteria:

1.1. Confirmed unresectable HCC

1.2. Child-Pugh score class A

1.3. Good performance status.

Evidence from the CheckMate 9DW study demonstrated that treatment with nivolumab in combination with ipilimumab resulted in at least comparable clinical benefit compared to lenvatinib or sorafenib for adults with unresectable or advanced HCC, preserved liver function, and ECOG PS of 0 or 1.

Treatment with nivolumab in combination with ipilimumab would be reasonable in the following scenarios at the discretion of the treating clinician:

  • patients with an ECOG PS of 2

  • patients who had partial resection, but failure to remove all HCC

  • patients with HCC where there is evidence of residual disease that can no longer be treated by locoregional therapies.

pERC noted that patients with fibrolamellar HCC, sarcomatoid HCC, or mixed cholangiocarcinoma and HCC were excluded from the CheckMate 9DW trial and should not be considered eligible.

2. Patients are ineligible for treatment with nivolumab in combination with ipilimumab if they have received any prior systemic treatment for unresectable or advanced HCC.

There is no evidence for the efficacy of nivolumab in combination with ipilimumab in patients who have received any systemic therapy for unresectable or advanced HCC. These criteria align with the CheckMate 9DW study population.

Treatment with nivolumab in combination with ipilimumab would be reasonable for patients who had received locoregional therapy (which is not considered systemic therapy).

For patients with HCC who are currently on other immunotherapy regimens (atezolizumab in combination with bevacizumab or durvalumab in combination with tremelimumab), whose disease has not progressed but who experience serious adverse effects (such as severe proteinuria or gastrointestinal perforation) or intolerance to their current treatment, it would be reasonable to consider switching to nivolumab in combination with ipilimumab on a limited time basis at the time of implementation.

Discontinuation

3. Reimbursement of nivolumab plus ipilimumab should be discontinued upon occurrence of:

3.1. disease progression

3.2. unacceptable toxicity

3.3. a maximum of 2 years of treatment.

Patients in the CheckMate 9DW study were given treatment for a maximum of 2 years from the start of the study treatment.

pERC noted that the CheckMate 9DW study did not provide evidence about re-treatment with nivolumab plus ipilimumab because patients received treatment for a maximum of 2 years. However, pERC agreed with the clinical experts and advised that if treatment with nivolumab in combination with ipilimumab was discontinued before the completion of 2 years of therapy for reasons other than progression or after the completion of 2 years of therapy, patients may receive an additional year of treatment with nivolumab plus ipilimumab if progression occurs more than 6 months after stopping treatment. The additional year of treatment should include nivolumab plus ipilimumab for a maximum of 4 cycles, followed by nivolumab monotherapy.

It would be reasonable to consider stopping treatment with ipilimumab and transitioning to nivolumab monotherapy earlier for patients who experience unacceptable toxicity.

Prescribing

4. Nivolumab plus ipilimumab should be prescribed by and managed under the care of clinicians with expertise in managing unresectable or advanced HCC.

This is meant to ensure that nivolumab plus ipilimumab is prescribed for patients for whom it is appropriate and that adverse effects are managed in an optimized and timely manner.

Due to the toxicities associated with nivolumab plus ipilimumab, particularly in the first year of treatment, pERC indicated that increased monitoring for immune-related adverse events (such as hepatitis) is likely required.

pERC agreed with the clinical experts that subcutaneous nivolumab would be a reasonable alternative to IV nivolumab for the single-agent phase of the indication under review.

pERC noted that jurisdictions may consider applying weight-based dosing to a cap for nivolumab maintenance and may dose at every 2 weeks or every 4 weeks, as clinically appropriate.

Pricing

5. The total treatment cost of nivolumab plus ipilimumab should be negotiated so that it does not exceed that of treatment with the least costly immunotherapy comparator (i.e., durvalumab plus tremelimumab or atezolizumab plus bevacizumab) for the same indication.

Based on the committee’s assessment of the evidence, no definitive conclusion could be drawn regarding the comparative efficacy and safety of nivolumab plus ipilimumab vs. durvalumab plus tremelimumab or atezolizumab plus bevacizumab due to the low certainty of the evidence submitted by the sponsor. Therefore, the total treatment cost of nivolumab plus ipilimumab should be no more than the least costly immunotherapy for the same indication.

Feasibility of adoption

6. The economic feasibility of adopting nivolumab plus ipilimumab must be addressed.

At the submitted price, the magnitude of uncertainty in the budget impact must be addressed to ensure the feasibility of adoption.

ECOG PS = Eastern Cooperative Oncology Group Performance Status; HCC = hepatocellular carcinoma; pERC = pan-Canadian Oncology Drug Review Expert Review Committee; vs. = versus.

aFor the statement regarding the size of the price reduction required, band 1 = 1% to 24%, band 2 = 25% to 49%, band 3 = 50% to 74%, and band 4 = 75% or greater.

Rationale for the Recommendation

Clinical Value

Based on the totality of the clinical evidence, pERC concluded that nivolumab plus ipilimumab demonstrates acceptable clinical value compared with TKIs (sorafenib and lenvatinib) and immunotherapies (atezolizumab plus bevacizumab, and durvalumab plus tremelimumab) in adult patients with unresectable or advanced HCC. Given that nivolumab plus ipilimumab is expected to be an alternative to TKIs or currently available immunotherapies, acceptable clinical value refers to at least comparable value versus TKIs and immunotherapies.

Evidence from 1 phase III, open-label, sponsor-blind, randomized controlled trial (CheckMate 9DW) demonstrated that treatment with nivolumab plus ipilimumab likely results in added clinical benefit for patients with unresectable or advanced HCC compared with the investigator’s choice of TKI (sorafenib or lenvatinib) in OS at 24 months. pERC noted that a detriment in OS was observed through the first 12 months when the Kaplan-Meier (KM) curves crossed; however, beyond 12 months, the curves remained separated, and at 24 months, nivolumab plus ipilimumab was likely associated with a clinically important increase in OS compared with sorafenib or lenvatinib. Results for progression-free survival (PFS) were similar in that the KM curves of PFS crossed between 9 and 12 months and remained separated in favour of nivolumab plus ipilimumab until 36 months.

Evidence from piecewise survival analyses of anchored simulated treatment comparisons (STCs) to other immunotherapies (atezolizumab plus bevacizumab, and durvalumab plus tremelimumab) suggested an improvement after 6 months in OS for the comparison between nivolumab plus ipilimumab and other immunotherapies (DUR + TRE: ██ █ ████ ████ ███ ████ ██ █████; ATE + BEV: ██ █ ████ ████ ███ ████ ██ █████, but this is associated with some uncertainty due to imprecision (i.e., the 95% confidence intervals [CIs] included the null, suggesting the potential for little to no difference). Similarly, according to the results for PFS at 6 months and beyond, nivolumab plus ipilimumab was favoured over durvalumab plus tremelimumab and atezolizumab plus bevacizumab. Overall, there is low certainty in the STC results primarily due to limitations such as a violation of the proportional hazards assumption within some of the segments using the 6-month cut point and heterogeneity that could not be accounted for due to the lack of a common comparator across studies.

Patients identified a need for treatments with improved tolerability, and clinicians identified a need for more effective treatment options that could lead to complete response and do not increase the risk of bleeding, or treatments that are potentially curative. pERC noted that nivolumab plus ipilimumab does not address these unmet clinical needs; however, it is an alternative immunotherapy option that may offer a clinical benefit for some patients beyond 6 months of treatment. pERC noted that a key limitation of the evidence is the absence of information identifying which patients are at a higher risk of mortality in the first 6 months of treatment.

Further information on the committee’s discussion around clinical value is provided in the Summary of Deliberation section.

Developing the Recommendation

The determination of acceptable clinical value was sufficient for pERC to recommend reimbursement of nivolumab plus ipilimumab. As part of the deliberation on whether to recommend reimbursement, the committee also considered unmet clinical need, unmet nonclinical need, and health inequity. Information on this discussion is provided in the Unmet Clinical Need and Distinct Social and Ethical Considerations domains in the Summary of Deliberation section.

Because pERC recommended that nivolumab plus ipilimumab be reimbursed, the committee also deliberated on whether reimbursement conditions should be added to address important economic considerations, health system impacts, or social and ethical considerations, or to ensure clinical value is realized. The resulting reimbursement conditions, with accompanying reasons and implementation guidance, are stated in Table 1.

Summary of Deliberation

pERC considered all domains of value of the deliberative framework before developing its recommendation: clinical value, unmet clinical need, distinct social and ethical considerations, economic considerations, and impacts on health systems. For further information on the domains of value, refer to Expert Committee Deliberation at Canada’s Drug Agency.

The committee considered the following key discussion points, organized by the 5 domains of value.

Clinical Value

Unmet Clinical Need

Distinct Social and Ethical Considerations

Economic Considerations

Impacts on Health Systems

Anticipated budget impact: It is estimated that 1,794 patients would be eligible for treatment with nivolumab plus ipilimumab over a 3-year period (year 1 = 577; year 2 = 601; year 3 = 616), of whom 199 are expected to receive nivolumab plus ipilimumab (year 1 = 29; year 2 = 84; year 3 = 86). The estimated budget impact of reimbursing nivolumab in combination with ipilimumab on the public drug plans in the first 3 years is estimated to be a savings of approximately $2 million, with a predicted expenditure of approximately $29 million on nivolumab plus ipilimumab (i.e., not accounting for the current expenditure on comparators). The actual budget impact will depend on the confidentially negotiated price of each comparator.

Sources of Information Used by the Committee

To make its recommendation, the committee considered the following information (links to the full documents of the review can be found on the project webpage):

pERC Information

Members of the Committee

Dr. Catherine Moltzan (Chair), Dr. Kelvin Chan (Vice-Chair), Paul Agbulu, Dr. Phillip Blanchette, Dr. Matthew Cheung, Dr. Michael Crump, Annette Cyr, Dr. Jennifer Fishman, Dr. Jason Hart, Terry Hawrysh, Dr. Yoo-Joung Ko, Dr. Aly-Khan Lalani, Amy Peasgood, Dr. Anca Prica, Dr. Michael Raphael, Dr. Adam Raymakers, Dr. Patricia Tang, Dr. Pierre Villeneuve, and Danica Wasney.

Meeting date: October 8, 2025

Regrets: Two expert committee members did not attend.

Conflicts of interest: None