p53/p16-Independent Epigenetic Therapy With Oral Decitabine/Tetrahydrouridine for Pancreatic Cancer

Primary Objective The primary goal of this pilot study is to detect decitabine therapy
induced DNMT1 protein level decreases with an effect size of 1 using a paired t-test and
alpha=0.05. The effect size is defined as the difference in mean DNMT1-protein levels between
post-treatment and pre-treatment divided by the standard deviation and is thus a metric of
change in the natural units of the distribution, its standard deviation. Our goal is thus to
detect drops in DNMT1 of at least one standard deviation.

Secondary Objectives Secondary goals include correlating DNMT1 decreases with clinical
response (measured by Response Evaluation Criteria in Solid Tumors [RECIST1.1]), using
logistic regression; time to relapse, using a Cox model; tolerability and safety assessment
by toxicity characterization using CTCAEv4.

Study Design Single-arm, open-label, proof-of-concept clinical trial in patients with
metastatic pancreatic cancer that has progressed on one or more lines of systemic therapy.

Inclusion Criteria:

- Histologically or cytologically proven pancreatic carcinoma or adenocarcinoma.
Histologies other than carcinoma/adenocarcinoma will not be eligible.

- Subjects must have received one or more prior systemic therapies for this disease,
with disease progression or intolerable toxicity precluding further therapy with prior
regimen(s).

- Measurable disease per RECIST 1.1.

- ECOG performance status 0 - 2

- Adequate organ function as defined by the following criteria:

- Serum aspartate transaminase (AST; serum glutamic oxaloacetic transaminase
[SGOT]) and serum alanine transaminase (ALT; serum glutamic pyruvic transaminase
[SGPT]) ≤ 2.5 x laboratory upper limit of normal (ULN)

- Total serum bilirubin ≤ 2.0 x ULN

- Absolute neutrophil count (ANC) ≥ 1500/uL

- Platelets ≥ 75,000/uL

- Hemoglobin ≥ 8.0 g/dL

- Serum calcium ≤ 12.0 mg/dL

- Serum creatinine ≤ 2.9 mg/dL

- Eligible and agreeable for percutaneous biopsy of a primary or metastatic lesion prior
to treatment and after approximately 16 weeks of treatment

- Patients with history of brain metastases can be enrolled at a minimum of 2 weeks
following the completion of surgery, gamma knife or whole brain radiotherapy. Repeat
brain MRI not required for eligibility.

- Subjects must have the ability to understand and the willingness to sign a written
informed consent document.

- At least two-weeks since receipt of prior standard or investigational therapy.

Exclusion Criteria:

- Any of the following within the 6 months prior to study drug administration:
myocardial infarction, severe/unstable angina, severe peripheral vascular disease
(claudication) or procedure on peripheral vasculature, coronary/peripheral artery
bypass graft, New York Heart Association grade II or greater congestive heart failure,
cerebrovascular accident or transient ischemic attack, clinically significant bleeding
or pulmonary embolism.

- Known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome
(AIDS)-related illness (HIV-positive subjects on combination antiretroviral therapy
are ineligible because of the potential for pharmacokinetic interactions with oral
THU-Dec. Appropriate studies will be undertaken in subjects receiving combination
antiretroviral therapy when indicated.

- Pregnancy or breastfeeding (pregnant or breastfeeding women are excluded from this
study because oral THU-Dec has the potential for teratogenic or abortifacient effects.
Because there is an unknown, but potential risk for adverse events in nursing infants
secondary to treatment of the mother with oral THU-Dec, breastfeeding should be
discontinued if the mother is treated with oral THU-Dec.

- Other severe acute or chronic medical or psychiatric conditions or laboratory
abnormality that may increase the risk associated with study participation or study
drug administration, or may interfere with the interpretation of study results, and in
the judgment of the investigator would make the patient inappropriate for entry into
this study.

- Receiving other investigational agent