A Phase 1b Safety Study of ARQ 197 in Cirrhotic Patients With Hepatocellular Carcinoma (HCC)

Inclusion Criteria:

- Written informed consent granted prior to initiation of any study-specific screening
procedures, given with the understanding that the patient has the right to withdraw
from the study at any time, without prejudice

- 18 year of age or older

- Histologically or cytologically confirmed HCC (not required if: a hepatic lesion is
>2cm in diameter , is suggestive of HCC at radiology and α-fetoprotein (AFP) is > 200
mg/mL)

- Barcelona Clinic Liver Cancer (BCLC) staging Category27 A, B or C that can not
benefit from treatments of established efficacy and/or higher priority

- Cirrhotic status of Child-Pugh Class A and B without ascites or with slight ascites
that can be recognized only by imaging techniques and/or managed easily with
diuretics (e.g. 100 mg spironolactone per day and/or furosemide 40 mg/day)

- Cirrhotic status confirmed by one of the following methods/evidence:

- Biopsy

- Endoscopy showing gastrointestinal tract varices

- Evidence of portal hypertension on imaging studies such as dilated portal vein,
collateral circulation

- ECOG PS ≤1

- Not more than two prior systemic regimens for HCC and the last treatment must have
been completed ≥4 weeks prior to first dose of ARQ 197

- Local or loco-regional therapy (i.e., surgery, radiation therapy, hepatic arterial
embolization, chemoembolization, radiofrequency ablation, percutaneous ethanol
injection, or cryoablation) must have been completed ≥4 weeks prior to first dose of
ARQ 197

- Measurable disease as defined by revised Response Evaluation Criteria in Solid Tumors
(RECIST), version 1.1. Tumor lesions selected as target lesion(s) at baseline should
not have been previously treated with local therapy (naïve tumor lesion)

- Adequate bone marrow, liver, and renal functions, defined as:

- Platelet count ≥ 60 × 10^9/L

- Hemoglobin ≥ 8.5 g/dL

- Absolute neutrophil count (ANC) ≥1.5 × 10^9/L

- Total bilirubin ≤ 3 mg/dL

- Alanine transaminase (ALT) and aspartate transaminase (AST) ≤ 5 × upper limit of
normal (ULN)

- Serum creatinine ≤1.5 × ULN

- International normalized ratio (INR) ≤ 2.3 or PT ≤ 6.0 seconds above control.
Patients who are therapeutically anticoagulated with an agent such as coumadin or
heparin are allowed to participate provided that no prior evidence of underlying
abnormality exists in these parameters

- Albumin ≥ 2.8 g/dL

- Women of childbearing potential must have a negative pregnancy test performed within
seven days prior to the start of study drug

- Male and female subjects of child-bearing potential must agree to use double-barrier
contraceptive measures, oral contraception, or avoidance of intercourse during the
study and for 90 days after last investigational drug dose received

Exclusion Criteria:

- Previous or concurrent cancer that is distinct from HCC in primary site or histology,
EXCEPT cervical carcinoma in situ, treated basal cell carcinoma, superficial bladder
tumors (Ta, Tis & T1). Any cancer curatively treated >3 years prior to enrollment is
permitted

- History of cardiac disease: congestive heart failure defined as Class II to IV per
New York Heart Association (NYHA) classification; active coronary artery disease
(CAD); previously diagnosed bradycardia or other cardiac arrhythmia, or uncontrolled
hypertension; myocardial infarction occurred within 6 months prior to study entry
(myocardial infarction occurred > 6 months prior to study entry is permitted)

- Active clinically serious infections defined as ≥ Grade 2 according to National
Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE),
version 3.0

- Substance abuse, medical, psychological or social conditions that may, in the opinion
of the Investigator, interfere with the patient's participation in the study or
evaluation of the study results

- Any condition that is unstable or which could jeopardize the safety of the patient
and his/her protocol compliance

- Known HIV (human immunodeficiency virus) infection

- Pregnancy or breast-feeding

- History of liver transplant

- Inability to swallow oral medications

- Clinically significant gastrointestinal bleeding occurring ≤4 weeks prior to first
dose of ARQ 197