Phase II Trial of Tivozanib in Advanced Hepatocellular Cancer

Angiogenesis is the formation of new blood vessels. Angiogenesis is driven by cyokines
including vascular endothelial growth factor. Tivozanib is an oral medication that inhibits
vascular endothelial growth factor preventing tumor from developing new blood vessels.

The purpose of this study is to evaluate the effects of tivozanib on hepatocellular (liver)
cancer. Participants in the study take tivozanib daily at a dose of 1 mg for 1month. if
doing well the dose would be increased to 1.5 mg per day. Patients are monitored for
response using CT or MRI scans every 2months. In addition, patients will have blood draws to
evaluate the effects of tivozanib on blood vessels.

Inclusion Criteria:

1. Patients with measurable, histological diagnosis of HCC and whose disease is not
amenable to surgical or regional therapy.

1. Prior allowed therapy:

- Surgery including hepatic resection

1. Minimum of 4 weeks since any surgical procedure.

2. Patients must have adequately recovered from surgery

- Regional therapy

1. Includes transarterial chemoembolization (TACE, DEB-TACE), percutaneous
ethanol injection, radiofrequency/cryo ablation, Yttrium-90
radioembolization

2. More than 2 weeks must have lapsed from therapy

3. There must be an indicator lesion outside the treated area or clear
evidence of progression in the treated lesion, not amenable for further
local therapies.

4. Concomitant sorafenib with regional therapy is allowed as long as no
evidence of progression on sorafenib

- Prior adjuvant sorafenib is allowed, if completed more than 6 months prior to
disease recurrence.

2. Adequate hematological, liver and metabolic organ function.

3. Signed informed consent.

Exclusion Criteria:

1. Patients with mixed histology or fibrolamellar variant.

2. Prior systemic therapy for metastatic disease

3. uncontrolled hypertension (HTN)

4. symptomatic heart failure