**3.4 Nivolumab**

Clinicians have also applied the use immunomodulatory checkpoint inhibitors as treatment for advanced HCC. Nivolumab is an immunoglobulin (IgG) 4 antibody that targets program death 1 (PD-1) on the surface of T cells to promote the antitumor properties of T cells [39]. Clinical trials have shown nivolumab to be a safe treatment option for advanced HCC with non-comparison studies showing durable and effective clinical response to treatment [40]. Multicenter phase III clinical trials comparing nivolumab to sorafenib are currently underway [41, 42]. Interim results of the CheckMate 459 trial, a randomized, multicenter phase III study, have shown no significant difference in median OS between nivolumab and sorafenib; however, the objective response rate was as high as 15% in those taking nivolumab vs. 7% in those taking sorafenib [41, 42]. Additionally, nivolumab was associated with superior health-related quality of life with patients reporting fewer side effects [43].
