A Phase I, Open-Labeled, Single-Arm, Dose Escalation, Clinical and Pharmacology Study of Dichloroacetate (DCA) in Patients With Recurrent and/or Metastatic Solid Tumours

Inclusion Criteria:

1. Patients must have histologically or cytologically confirmed recurrent or metastatic solid tumours. All patients will have no meaningful therapies available to them including hormone therapy, chemotherapy and targeted therapies. For the malignancies that have no proven therapy, they can be enrolled without any prior systemic therapy.
2. Four weeks must have elapsed since prior chemotherapy, hormonal therapy, targeted therapy, or radiation therapy. There is no restriction in the amount of bone marrow previously radiated.
3. Recovery to baseline or, at most, grade 1 of all drug-related toxicities due to prior chemotherapy, radiation, hormonal therapy, or molecular targeted therapy, except for alopecia.
4. Age ≥ 18 years.
5. ECOG performance status ≤ 2 (Karnofsky ≥70%, see Appendix A).
6. Life expectancy of greater than 12 weeks.
7. Patients must have normal organ and marrow function as defined below:

   * absolute neutrophil count ≥1,500/mcL
   * hemoglobin ≥90 g/L
   * platelets ≥100,000/mcL
   * total bilirubin ≤1.5 X upper limit of normal (ULN)
   * AST(SGOT) and ALT(SGPT) ≤2.5 X ULN or ≤ 5 X ULN in the presence of liver metastases
   * creatinine ≤1.5 X institutional upper limit of normal
8. Cardiac ejection fraction by MUGA scan or echocardiogram must be \>50% for patients at baseline.
9. The effects of DCA on the developing human fetus are unknown. For this reason and because DCA can be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (e.g.: hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
10. Ability to understand the purpose of the study and the willingness to sign a written informed consent document.

Exclusion Criteria:

1. Patients who have had chemotherapy, hormonal therapy, molecular targeted therapy, or radiotherapy within 4 weeks prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier.
2. Patients may not be receiving any other investigational agents, chemotherapy, immunotherapy, radiotherapy, or molecular targeted agents.
3. Patients with known brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that could confound the evaluation of neurologic and other adverse events.
4. History of allergic reactions attributed to compounds of similar chemical or biologic composition to DCA.
5. Due to the possibility of peripheral sensorimotor neuropathy from DCA, the presence of grade 2 or higher peripheral neuropathy due to prior medical condition (such as multiple sclerosis), medications, or other etiologies.
6. Any psychological, familial, sociological, or geographical conditions that do not permit medical follow-up and compliance with the study protocol.
7. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. Specifically, for patients who are taking either or both oral hypoglycemics and insulin for diabetes mellitus will not be eligible as DCA in combination with these agents may increase the risk of clinically significant hypoglycemia, compromising patient safety.
8. Pregnant women are excluded from this study because DCA is an agent with 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 DCA, breastfeeding should be discontinued if the mother is treated with DCA.
9. HIV-positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with DCA. In addition, these patients are at increased risk of lethal infections when treated with marrow-suppressive therapy. Appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated.
10. 5 years must have elapsed since the initial curative procedure for other malignancies, except for in situ cervical cancer, basal cell carcinoma of the skin, and localized prostate cancer after curative therapy such as surgery, or radiation.
11. History of malabsorption syndrome or substantial amount of small bowels or stomach removed that may impair absorption of DCA.
12. Patients taking warfarin. Low dose or therapeutic dose of heparin or low molecular weight heparin is allowed.