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Forty-two patients received nivolumab 480\u2009mg every 4\u2009weeks and regorafenib 80\u2009mg daily (3-weeks-on\/1-week-off schedule). The primary endpoint was the investigator-assessed objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. The secondary endpoints included safety, progression-free survival (PFS) and overall survival (OS). ORR per RECIST version 1.1 was 31.0%, meeting the primary endpoint. The most common adverse events were palmar-plantar erythrodysesthesia syndrome (38.1%), alopecia (26.2%) and skin rash (23.8%). Median PFS was 7.38\u2009months. The 1-year OS rate was 80.5%, and the median OS was not reached. Exploratory single-cell RNA sequencing analyses of peripheral blood mononuclear cells showed that long-term responders exhibited T cell receptor repertoire diversification, enrichment of genes representing immunotherapy responsiveness in\n                    <jats:italic>MKI67<\/jats:italic>\n                    <jats:sup>+<\/jats:sup>\n                    proliferating CD8\n                    <jats:sup>+<\/jats:sup>\n                    T cells and a higher probability of M1-directed monocyte polarization. Our data support further clinical development of the regorafenib\u2013nivolumab combination as front-line treatment for uHCC and provide preliminary insights on immune biomarkers of response. 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H.-D.K. received honoraria from AstraZeneca, Bristol Myers Squibb, Ono Pharmaceuticals, Boryung Pharmaceuticals, Eisai, Daehwa and Boostimmune and served as a consultant for Mustbio. H.J.C. holds consulting or advisory roles with Eisai, Roche, Bayer, Ono Pharmaceuticals, Merck Sharp & Dohme, Bristol Myers Squibb, Sanofi, Servier, AstraZeneca, SillaJen, Menarini and GreenCross Cell and has received research grants from Roche, Dong-A ST and Boryung Pharmaceuticals. D.T. received honoraria from Novartis, Celgene, Sirtex, Merck Sharp & Dohme, Eisai, Ipsen, Bayer, GlaxoSmithKline, Roche and AstraZeneca and research support from Novartis, Sirtex and Bristol Myers Squibb. R.S.F. reports grants or contracts to institution from Adaptimmune, Bayer, Bristol Myers Squibb, Eisai, Eli Lilly, Pfizer, Roche and Genentech; personal consulting fees from Merck, AstraZeneca, Bayer, Bristol Myers Squibb, Exelixis, Cstone, Hengrui, Eisai, Eli Lilly, Merck Sharp & Dohme, Pfizer, Roche and Genentech; personal payments or honoraria from Genentech; and participation on a data safety monitoring or advisory board for AstraZeneca and Hengrui. All other authors have no competing interests to disclose.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}