Clinical Trial Finder

Inclusion Criteria:

• - Patients must have signed and dated an Institutional Review Board/Independent Ethics Committee -approved written informed consent form in accordance with regulatory and institutional guidelines.

This must be obtained before the performance of any protocol-related procedures that are not part of normal patient care.

• - Patients must be willing and able to comply with scheduled visits, treatment schedule, laboratory tests, tumor biopsies, and other requirements of the study.

• - All patients must be either Stage IIIb/c/d or Stage IV according to the American Joint Committee on Cancer (AJCC) (8th edition) and have histologically-confirmed melanoma that is felt to be surgically unresectable in order to be eligible.

Please refer to the AJCC Cancer Staging Manual, 8th edition for a description of tumor, lymph node, metastasis and staging.

• - All melanomas, except ocular/uveal melanoma, regardless of primary site of disease will be allowed; mucosal melanomas are eligible.

• - Patients must not have received prior anticancer treatment for metastatic disease (for example, but not limited to, systemic, local, radiation, radiopharmaceutical).

oExceptions: Surgery for melanoma and/or post-resection brain radiotherapy (RT) if central nervous system (CNS) metastases and local radiation for locoregional disease and/or prior treatment with adjuvant nivolumab, dabrafenib and trametinib, pembrolizumab, interferon (IFN) or ipilimumab (IPI) (as described in Exclusion Criterion 8,4 full protocol below).

• - All patients must have their disease status documented by a complete physical examination and imaging studies within 4 weeks prior to the first dose of study drug.

Imaging studies must include computerized tomography (CT) scan of chest, abdomen, pelvis, and all known sites of resected disease in the setting of Stage IIIb/c/d or Stage IV disease, and brain magnetic resonance imaging ([MRI]; brain CT is allowable if MRI is contraindicated).

• - Disease must be measurable by RECIST 1.1.

• - The complete set of baseline radiographic images must be available before treatment initiation.

Exclusion Criteria:

• - Patients with untreated brain metastases, carcinomatosis meningitis or current ocular/uveal melanoma are excluded.

• - Patients with previous non-melanoma malignancies are excluded unless a complete resection or remission was achieved at least 2 years prior to study entry and no additional therapy is required or anticipated to be required during the study period (exceptions include, but are not limited to, non-melanoma skin cancers, in situ bladder cancer, in situ gastric cancer or gastrointestinal stromal tumor, in situ colon cancers, in situ cervical cancers/dysplasia, or breast carcinoma in situ).

• - Patients with active, known, or suspected autoimmune disease.

Patients with type I diabetes mellitus, residual hypothyroidism due to autoimmune thyroiditis only requiring hormone replacement, or skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment are permitted to enroll. For any cases of uncertainty, it is recommended that the Principal Investigator be consulted prior to signing informed consent.

• - Patients with a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone or equivalent) or other immunosuppressive medications within 14 days of study drug administration.

Inhaled or topical steroids are permitted in the absence of active autoimmune disease

In this Phase II, open-label study, the treatment period will consist of an induction phase and a maintenance phase. The induction phase consists of an induction treatment cycle of 8 weeks which is the DLT period. The maintenance phase consists of treatment cycles of 56 days (8 weeks) each, and may extend up to 2 years. During the induction phase, ipilimumab will be administered on day 1 at a dose of 1 mg/kg intravenously (IV) during the 8-week induction period, concurrent with nivolumab 480 mg/relatlimab at 160 mg, fixed dose, administered at a 4 week interval on days 1 and 29 with a 30 minute rest period between the two infusions on day 1 and 29. On days administered in combination, nivolumab/relatlimab will be administered first at a dose of 480 mg/160 mg, followed by ipilimumab at 1 mg/kg, and immediately followed by sarilumab at 150 mg given subcutaneously. Nivolumab/relatlimab and ipilimumab will be each administered IV over 30 minutes consecutively with a 30-minute rest period between infusions, on day 1 of the first and all subsequent 56-day maintenance treatment cycles and nivolumab/relatlimab will be administered on day 29 of each cycle. Sarilumab will be administered subcutaneously every 2 weeks during the 56-day induction treatment cycle and the first two 56-day maintenance cycles only for a total of 24 weeks

Arms

Experimental: Study Group

Participants receive sarilumab at 150 mg flat dose is administered subcutaneously every 2 weeks for 12 doses from day 1, cycle 1 in combination with a regimen of ipilimumab at 1 mg/kg every 8 weeks and fixed dose nivolumab at 480 mg and relatlimab at 160 mg flat dose every 4 weeks two times during the 8-week induction period, then the same regimen again up to week 16, and up to week 24 in maintenance. After week 24 the regimen will be ipilimumab at 1 mg/kg every 8 weeks and fixed dose nivolumab at 480 mg with relatlimab at 160 mg flat dose every 4 weeks for 8 week cycles for up to a total of 2 years in patients with unresectable Stage III/Stage IV melanoma.

Interventions

Drug: - Sarilumab

Injectable solutions of sarilumab are formulated in 2 mL of aqueous solution in a 5 mL vial containing 175 mg/ml of sarilumab arginine (8.94 mg), histidine (3.71 mg), polysorbate 20 (2.28 mg), sucrose (57 mg) and Water for Injection USP.Patients will be administered sarilumab at a dose of 150 mg subcutaneously in combination with ipilimumab, nivolumab and relatlimab given intravenously, with nivolumab/relatlimab given intravenously, or sarilumab at a dose of 150 mg subcutaneously given alone.

Drug: - Ipilimumab Injection

Ipilimumab injection is a sterile, nonpyrogenic, clear to slightly opalescent, colorless to pale yellow solution, single-use, preservative-free, isotonic aqueous solution that may contain particles. It is formulated at a concentration of 5 mg/mL ipilimumab in TRIS hydrochloride (also known as 2-amino-2-hydroxymethyl-1,3-propanediol hydrochloride), sodium chloride, mannitol, pentetic acid (also known as diethylenetriaminepentaacetic acid or DTPA), polysorbate 80, and water at pH 7.0. Sodium hydroxide and/or hydrochloric acid may be used to adjust the pH of the solution. Ipilimumab Injection 200 mg/40 mL (5 mg/mL) is packaged in a 50-cc Type I flint molded glass vials.

Drug: - Nivolumab/Relatlimab

The FDC drug product, referred to as nivolumab/relatlimab, contains relatlimab and nivolumab in a single vial in a kit of 2 vials. The product is a sterile, non-pyrogenic, single-use, isotonic aqueous solution for IV infusion. It is formulated at a total protein concentration of 16 mg/mL (4 mg/mL relatlimab and 12 mg/mL nivolumab) and is packaged in a 20-cc glass vial in a kit of two vials. Each vial contains 80 mg of relatlimab and 240 mg of nivolumab.