| Eligibility |
Inclusion Criteria:
- Adults = 18 years old
- Must have evidence of progressive disease (PD) by RECIST 1.1 criteria while receiving
adjuvant aPD1 therapy, or progression within 6 months after completing adjuvant
treatment for stage IIB-IV melanoma
- Patients with stage IV nonresectable disease with rare melanoma subtypes: (mucosal,
acral, uveal, non-sun exposed) are eligible for the study if they fail to response to
initial immunotherapy given in the first line metastatic setting. These rare subtypes
do not respond to aPD1 blockade at the same rate or degree as cutaneous melanomas and
behave more like adjuvant failure patients in response to aPD1. These patients must
have disease amenable to sampling and in the opinion of the treating physician have
appropriate bridging therapy available to reach vaccination series, have no other
approved therapeutic options/or decline their use.
- Must have received either PD1 or combination aPD1/CTLA-4 inhibition as adjuvant
treatment for stage IIB-IV melanoma following surgical resection
- Must be BRAF wildtype
- ECOG performance = 1
- Lab values within the specified ranges:
- Serum direct bilirubin = 1.5 x ULN (upper limit of normal)
- AST and ALT = 2.5 x ULN (If confirmed liver metastases: AST and ALT= 5 x ULN)
- Creatinine clearance (CrCl) = 15 ml/min (based on modified Cockcroft and Gault
formula)
- Must have disease that is amendable to surgical sampling for RNA-NP vaccine
development
- Subjects must not have more than one active malignancy at the time of enrollment
(subjects with a prior or concurrent malignancy whose natural history or treatment
does not have the potential to interfere with the safety or efficacy assessment of the
investigational regimen [as determined by the treating physician and approved by the
PI] may be included)
- Written informed consent obtained from the subject. Subject agrees to comply with all
the study-related procedures.
- Female subjects of childbearing potential must have a negative serum pregnancy test at
screening
- Women of childbearing potential (WOCBP) must be using an adequate method of
contraception to avoid pregnancy throughout the study and for at least four months
after the last dose of study treatment to minimize the risk of pregnancy. Prior to
study enrollment, women of childbearing potential must be advised of the importance of
avoiding pregnancy during trial participation and the potential risk factors for an
unintentional pregnancy.
WOCBP includes any woman who has experienced menarche and who has not undergone successful
surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy)
or who is not post-menopausal Post-menopause is defined as:
- Amenorrhea that has lasted for = 12 consecutive months without another cause, or
- For women with irregular menstrual periods who are taking hormone replacement therapy
(HRT), a documented serum follicle-stimulating hormone (FSH) level of greater than 35
mIU/mL.
- Males with female partners of child-bearing potential must agree to use
physician-approved contraceptive methods (e.g., abstinence, condoms, vasectomy)
throughout the study and should avoid conceiving children for four months
following the last dose of study treatment and must agree to not donate sperm
during the study treatment period
Exclusion Criteria:
- Subjects that have an active second malignancy, however, previously treated early
stage malignancies (non-melanoma skin cancers, ductal carcinoma in situ, or prostate
confined prostate cancer) with no evidence of disease recurrence after 5 years of
follow-up will be allowed
- Subjects with a history of immune-mediated treatment-related adverse reactions leading
to discontinuation of prior aPD1 therapy or severe hypersensitivity reaction to any
monoclonal antibody or any other baseline risk in the opinion of the investigator that
precludes continued use of aPD1 therapy
- Subjects who received an investigational drug in another clinical trial must wait 28
days or at least 5 half-lives of the study drug, whichever is shorter, prior to
enrollment in this study
- Subjects with uncontrolled infection requiring parenteral antibiotics, antivirals, or
antifungals within seven days prior to tissue collection for vaccine creation or
within even days prior to vaccine administration (subjects on prophylactic agents are
acceptable)
- Subjects with any life-threatening illness, medical condition, or organ system
dysfunction, which in the investigator's opinion, could compromise subject safety
- Subjects with known active hepatitis B virus or untreated hepatitis C virus
- Clinically relevant active autoimmune disease
- Symptomatic congestive heart failure (NYHA 3 or 4)
- Subjects with unstable angina pectoris
- Subjects who are post-splenectomy
- Known hypersensitivity to the active substance or to any of the excipients
- Subjects with human immunodeficiency virus with CD4+T cells = 350 cells/ul, a positive
viral load as determined by institutional standard testing, or a history of AIDS
defining opportunistic infection within the last 12 months
- Females or males of childbearing potential who are unwilling or unable to use an
acceptable method to avoid pregnancy for the entire study period and for at least 4
months after the last dose of study treatment
- Females who are confirmed to be pregnant or breastfeeding
- History of any other disease, metabolic dysfunction, physical examination finding, or
clinical laboratory finding giving reasonable suspicion of a disease or condition that
contraindicates the use of protocol therapy or that might affect the interpretation of
the results of the study or that puts the subject at high risk for treatment
complications, in the opinion of the treating physician
- Administration of a vaccine containing live virus within 30 days prior to the first
dose of trial treatment. Note: Most flu vaccines are killed viruses, with the
exception of the intra-nasal vainer (Flu-Mist) which is an attenuated live virus and
therefore prohibited for 30 days prior to first dose. Non-live versions of the COVID
vaccine are allowed.
- Prisoners or subjects who are involuntarily incarcerated, or subjects who are
compulsorily detained for treatment of either a psychiatric or physical illness.
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