Phase II Trial of SOM230 in Patients With Unresectable Hepatocellular Carcinoma

Inclusion Criteria:

- 1. Diagnosis of unresectable HCC by either:

- Histopathology or

- Elevated serum AFP>400 ng/ml and findings on magnetic resonance imaging (MRI) or
CT scans characteristic of a primary liver tumor.

- Findings on MRI or CT scans characteristic of a primary liver tumor in patients
with cirrhosis

- Tumors at least 1 cm or greater

- 2. Age ≥ 18 years.

- 3. Minimum of four weeks since any major surgery, completion of radiation,or
completion of all prior systemic anticancer therapy (adequately recovered from the
acute toxicities of any prior therapy).

- 4. Patients may have progressed on sorafenib or refused or were intolerant of
sorafenib. A maximum of 2 prior lines of systemic therapy (including chemotherapy or
targeted therapy) will be allowed. Prior locoregional therapy such as surgery,
radiofrequency ablation or transarterial chemoembolization are also allowed (these
will not be counted as systemic therapy), provided that progression has been
documented after these therapies, and at least 4 weeks have elapsed since the last
therapy.

- 5. Karnofsky performance status (KPS) of 80 or Eastern Cooperative Oncology
Group(ECOG) performance status of 0 or 1.

- 6. Life expectancy 12 weeks or more.

- 7. Adequate bone marrow function as shown by: ANC ≥ 1.2 x 10^9/L, Platelets ≥ 50 x
10^9/L

- 8. Adequate liver function as shown by: serum bilirubin < 1.5x ULN and serum
transaminases activity ≤ 3 x ULN. Serum PT =< 16 seconds.

- 9. Adequate renal function as shown by serum creatinine ≤ 1.5 x ULN.

- 10. Fasting serum cholesterol ≤300 mg/dL OR ≤7.75 mmol/L AND fasting triglycerides ≤
2.5 x ULN. NOTE: In case one or both of these thresholds are exceeded, the patient
can only be included after initiation (can start after one day of initiation of lipid
lowering drug) of appropriate lipid lowering medication.

- 11. Women of childbearing potential must have a negative serum or urine pregnancy
test within 14 days of the administration of the first study treatment. Women must
not be lactating. Both men and women of childbearing potential must be advised of the
importance of using effective birth control measures during the course of the study.

- 12. Signed informed consent to participate in the study must be obtained from
patients after they have been fully informed of the nature and potential risks by the
investigator (or his/her designee) with the aid of written information.

- 13. Child's A and early Child's B (no more than 7 points on the Child Pugh
Classification).

- 14. Measurable disease by CT scan with contrast. If evaluable disease or measurable
disease has been previously treated, this must show signs of tumor progression by CT.
Measurable disease and evaluable disease will be defined by the RECISTguidelines (see
section 9.0).

- 15. Patients with cirrhosis either radiologically or pathology with findings either
by CT scan or MRI characteristic of primary liver cancer are eligible.

Exclusion Criteria:

- 1. Prior octreotide therapy or any somatostatin analog.

- 2. Chronic treatment with systemic steroids or another immunosuppressive agent.

- 3. Patients should not receive immunization with attenuated live vaccines during
study period or within 1 week of study entry (ie. within 1 week of signing the
informed consent).

- 4. Uncontrolled brain or leptomeningeal metastases, including patients who continue
to require glucocorticoids for brain or leptomeningeal metastases.

- 5. Patients with prior or concurrent malignancy except for the following: adequately
treated basal cell or squamous cell skin cancer, or other adequately treated in situ
cancer, or any other cancer from which the patient has been disease free for five
years.

- 6. Patients with uncontrolled diabetes mellitus (defined as HgA1c > 7% or =8% despite
therapy) or a fasting plasma glucose > 1.5 ULN. Note: At the principle investigator's
discretion, non-eligible patients can be re-screened after adequate medical therapy
has been instituted.

- 7. Patients with symptomatic cholelithiasis

- 8. Patients who have congestive heart failure (NYHA Class III or IV), unstable
angina,sustained ventricular tachycardia, ventricular fibrillation, clinically
significant bradycardia, advanced heart block or a history of acute myocardial
infarction within the six months preceding enrollment.

- 9. Patients who are at high risk for cardiac arrhythmias as defined by any of the
following:

- Baseline QTcF > 470 msec

- History of syncope or family history of idiopathic sudden death or long QT
syndrome

- Sustained or clinically significant cardiac arrhythmias

- Risk factors for Torsades de Pointes such as hypokalemia, hypomagnesemia,
cardiac failure, clinically significant/symptomatic bradycardia, or high-grade
AV block

- Concomitant disease(s) that could prolong QT such as autonomic neuropathy
(caused by uncontrolled diabetes, or Parkinson's disease), HIV, uncontrolled
hypothyroidism or cardiac failure

- Concomitant medication(s) known to increase the QT interval (see Appendix II)

- 10. Patients with the presence of active or suspected acute or chronic uncontrolled
infection or with a history of immunocompromise, including a positive HIV test result
(ELISA and Western blot).

- 11. Patients who have any severe and/or uncontrolled medical conditions or other
conditions that could affect their participation in the study such as:

- Severely impaired lung function

- Any active (acute or chronic) or uncontrolled infection/ disorders.

- Nonmalignant medical illnesses that are uncontrolled or whose control may be
jeopardized by the treatment with the study therapy

- 12. Women who are pregnant or breast feeding, or women/men able to conceive and
unwilling to practice an effective method of birth control. (Women of childbearing
potential must have a negative serum pregnancy test within 14 days prior to
administration of pasireotide). Oral, implantable, or injectable contraceptives may
be affected by cytochrome P450 interactions, and are therefore not considered
effective for this study.

- 13. Known hypersensitivity to somatostatin analogues or any component of the
pasireotide or octreotide LAR formulations

- 14. History of noncompliance to medical regimens

- 15. Patients unwilling to or unable to comply with the protocol or unable to give
informed consent.

- 16. Patients with baseline ALT or AST > 3x ULN.

- 17. Patients with baseline serum bilirubin > 1.5 x ULN.

- 18. PT > 16 seconds and/or PTT > 1.5 x ULN

- 19. History of or current alcohol misuse/abuse within the past 12 months.

- 20. Known gallbladder or bile duct disease, acute or chronic pancreatitis.