A Study of Vitamin C in the Treatment of Liver Cancer to Determine if it is Safe and Effective

Intravenous Ascorbic Acid (Vitamin C) is a widely used alternative cancer treatment. This
trial will study an intravenous Vitamin C treatment for persons with liver cancer that has
spread, who are also receiving Sorafenib (a standard cancer drug), to see whether the
combination of Vitamin C and Sorafenib is safe and well tolerated. Phase I will involve 6
persons who will receive the Vitamin C for 8 weeks to more specifically assess the safety of
getting Vitamin C in combination with Sorafenib. Phase II will be randomized to receive
either Vitamin C plus Sorafenib or Sorafenib alone for 16 weeks. If Vitamin C has a
beneficial effect on tumour cells, patients may experience a regression of tumor or tumor
markers. Additional benefits include scans at no charge to the patient.

Inclusion Criteria:

- Age > 18 years

- Metastatic hepatocellular carcinoma

- G6PD (glucose-6-phosphate dehydrogenase) status > lower limit of normal

- Eastern Cooperative Oncology Group (ECOG) performance status 0 to 2.

- Laboratory at baseline evaluation for inclusion in the study: creatinine ≤1.5X upper
limit (if the creatinine is elevated, but ≤1.5X the ULN, a 24 hour creatinine
clearance will be obtained); transaminase (AST/ALT) ≤2.0X upper limit of normal;
bilirubin levels ≥ 2 mg/dL; ANC ≥1,500/mm3; Hemoglobin > 8g/dL; platelet ≥ 100,000/mm3

- Women of childbearing potential will confirm a negative pregnancy test and must
practice effective contraception during the study.

- Willing and able to provide informed consent and participate in the study procedures.

Exclusion Criteria:

- Patients with evidence of a significant current psychiatric disorder that would
prevent completion of the study as determined by the PI will not be allowed to
participate.

- Co-morbid medical condition that would affect survival or tolerance as determined by
the PI. This includes patients who have not fully recovered from toxicities associated
with prior therapy. It also includes subjects who, as determined by the PI, are at
risk of experiencing fluid overload (i.e., congestive heart failure).

- Patients who currently abuse alcohol or drugs.

- Patients with known glomerular filtration rate of <60ml/min or with nephrotic range
proteinuria.

- Pregnant or lactating women

- Enrollment in active clinical trial/ experimental therapy or IND study within the
prior 30 days.

- Contraindication for CT or PET/CT as per the PI.