Study of Tocilizumab in Patients With Hepatocellular Carcinoma (HCC) Undergoing Transarterial Chemoembolization (TACE)

TACE (Transarterial Chemo Embolization) has shown to improve overall survival compared to
non-treated patients with intermediate HCC (Hepatocellular Carcinoma) tumors. However, TACE
is not considered a curative strategy and eventual local recurrence is observed in nearly
all (>95%) of cases. Therefore, significant clinical equipoise exists in this large group of
HCC patients such that novel therapies can be tested in an adjuvant manner to TACE. Based on
pre-clinical data in HCC and the increasing identification that IL-6 signaling leads to
tumor progression or local recurrence in other solid malignancies, significant rationale
exists for the use of Tocilizumab, an IL-6 receptor inhibitor adjuvant to TACE. While
Tocilizumab has been demonstrated to be safe in RA patients and is FDA approved, limited
data exists for the maximum tolerated dose (MTD) in patients with cirrhosis and HCC.
Therefore, a lead in phase IB study design is planned to identify the MTD of Tocilizumab in
HCC patients followed by expansion to the phase II component whereupon the primary objective
will be median progression free survival (PFS).

Inclusion Criteria:

- Histologic evidence of HCC, Barcelona-Clinic Liver Cancer (BCLC) stage B

- FFPE (Fixed-paraffin Embedded) tumor tissue (two cores preferred) for biomarker
analysis

- Prior radioembolization, local ablative therapies (radiofrequency, microwave or
cryoablation), radiation (external beam or stereotactic), or hepatic resection
permitted if completed ≥ 4 weeks prior to study enrollment and if patient has
recovered with ≤ grade 1 toxicity and if untreated measurable disease is present.

- Radiographically measurable disease by mRECIST in at least one site not previously
treated by local therapies.

- Must not be receiving treatment with other investigational agents and must not have
received any other investigational agent's ≤ 4 weeks prior to registration.

- Age ≥ 18 years.

- Eastern Cooperative Oncology Group (ECOG) performance status of 0-1

- Required lab and acceptable range criteria.

- Women of child-bearing potential and men must agree to use 2 methods of adequate
contraception.

- No contraindications to TACE therapy

- Child-Pugh Score A-B

- Ability to understand and the willingness to sign a written informed consent, and the
willingness to comply with the requirements of the protocol.

- Life expectancy greater than 3 months.

- Adequate baseline organ and marrow function

Exclusion Criteria:

- History of hepatitis B

- Women must not be pregnant or breastfeeding

- Presence of other malignancies

- Active or history of Tuberculosis

- Patients with known HIV positive status

- Conditions with impaired immunity or on immunosuppressive medications such as oral
steroids, calcineurin inhibitors, or anti-proliferative agents.

- Must have no evidence of significant, uncontrolled concomitant diseases

- Must have no ongoing or active, uncontrolled infections