A phase Ib study of selumetinib (AZD6244, ARRY-142886) in combination with sorafenib in advanced hepatocellular carcinoma (HCC).

Angiogenesis and RAS/RAF/MEK/ERK pathway have been demonstrated to be relevant in hepatocellular carcinoma (HCC). Sorafenib, an oral multikinase inhibitor with activity against RAF kinase and vascular endothelial growth factor receptor-2, is approved for the treatment of advanced HCC. The therapeutic benefit however is modest. While displaying tumour growth inhibition and angiogenesis, sorafenib treatment in pre-clinical models exhibited up-regulation of pERK which may limit its anti-tumour activity. Inhibition of the MEK/ERK pathway by selumetinib enhanced the anti-tumour effect of sorafenib in pre-clinical models of HCC. In this phase I study, we investigated the maximum tolerated dose (MTD), safety and activity of combination sorafenib and selumetinib in patients with advanced HCC. The combination of selumetinib and sorafenib has manageable toxicity and showed encouraging anti-tumour activity. These findings support further evaluation in a phase II study.