MNA-3521-011 study is a multi-centre, open-label, first-in-human, phase 1a/b clinical study dose/dose frequency escalation followed by a cohort expansion part. MTL-CEBPA is administered as monotherapy or in combination with sorafenib to patients with advanced hepatocellular carcinoma and cirrhosis of the liver. All participants will be considered unsuitable for liver tumour resection and/or is refractory to radiotherapy and other loco-regional therapies.

MTL-CEBPA consists of a double stranded RNA formulated into a SMARTICLES® liposomal nanoparticle and is designed to activate the CEBPA gene.

Inclusion Criteria:

• Histologically confirmed advanced HCC with cirrhosis resulting from hepatitis B, hepatitis C, alcohol-related liver disease or any other aetiology OR Histologically confirmed advanced HCC resulting from NASH with or without cirrhosis

• Patient is considered unsuitable for liver tumour resection and/or is refractory to radiotherapy and other loco-regional therapies

• At least one measurable lesion with target lesion size ≥ 1.0 cm as measured by MRI or CT

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

• Child-Pugh class A or B (up to B7)

• Eligible to undergo pre and post treatment mandated biopsies

• Acceptable laboratory parameters, as demonstrated by:

  • Platelets ≥ 70 x 10^9/L
  • Serum albumin > 26 g/L
  • ALT and AST ≤ 5 x ULN
  • Bilirubin ≤ 50 µmol /L
  • WBC ≥ 2.0 x 10^9/L, Absolute neutrophil count ≥ 1.5 x 109/L
  • Haemoglobin ≥ 9.0 g/dL
  • Prothrombin time (PT) <20 seconds

• Acceptable renal function as demonstrated by:

  • Serum creatinine ≤ 1.5 x ULN
  • Calculated creatinine clearance ≥ 60 mL/min

Exclusion Criteria:

• Patients who have been treated with TACE or chemotherapy within the last 28 days
• Prior investigational drugs within the last 30 days
• Grade > 1 prior treatment-related toxicities (excluding alopecia) at the time of screening
• Patients with clinically significant cancer ascites
• Any episode of bleeding from oesophageal varices or other uncontrolled bleeding within the last 3 months prior to study treatment initiation
• Patients with history of haemorrhage or gastrointestinal perforation
• Patients administered with serum albumin within the last 7 days prior to the first study drug administration
• Known infection with human immunodeficiency virus (HIV)
• Patients with central nervous system (CNS), bone or peritoneal metastasis
• Patients presenting with marked baseline prolongation of QT/QTc interval defined as repeated demonstration of a QTc interval ≥450 ms (males) and ≥460 ms (females) using Fridericia's correction formula
• Signs and symptoms of heart failure characterised as greater than the New York Heart Association (NYHA) Class I or other clinically significant cardiac abnormalities (including history of myocardial infarction) including stable abnormalities.
• Major surgery within the last 30 days prior to study treatment initiation
• Patients with history of organ transplantation or cardiac surgery
• Patients with sepsis, ineffective biliary drainage with or without cholangitis, obstructive jaundice or encephalopathy at screening visit or within the last two weeks prior to study treatment initiation, whichever earlier
• Evidence of spontaneous bacterial peritonitis or renal failure or allergic reactions to the agent or excipient at screening visit or within the last two weeks prior to study treatment initiation, whichever earlier
• Known hypersensitivity to the active sorafenib or to any of the excipients
• Occurrence of a grade 3 or higher sorafenib or lenvatinib related toxicity during any sorafenib / lenvatinib treatment received prior to study enrolment, according to toxicity criteria (NCI CTCAE v 5.0)
• Pregnant or lactating women