Inclusion Criteria:
- - Male/female participants who are at least 18 years of age on the day of signing
informed consent with histologically confirmed diagnosis of unresectable or metastatic
cutaneous melanoma will be enrolled in this study.
- - Male participants: A male participant must agree to use a contraception during
the treatment period and for at least 6 days (140 hours) plus an additional 90
days (a spermatogenesis cycle) after the last dose of study treatment and refrain
from donating sperm during this period.
- - Female participants: A female participant is eligible to participate if she is
not pregnant, not breastfeeding, and at least one of the following conditions
applies:
- Not a woman of childbearing potential (WOCBP) OR.
- - A WOCBP who agrees to follow the contractive guidance during the treatment
period and for at least 6 days (140 hours) plus 120 days after the last
treatment dose of study.
- - Participants must have progressed on treatment with an anti-PD-1/L1 monoclonal
antibody (mAb) administered either as monotherapy or in combination with other
checkpoint inhibitors or other therapies.
PD-1 inhibitor treatment progression is
defined by meeting the following criteria:
- - For patients treated with anti-PD-1/L1 mAb in the unresectable/metastatic
setting:
- Has received at least 2 doses of an approved anti-PD-1/L1 mAb.
- - Has demonstrated disease progression after anti-PD-1/L1 as defined by
Immune-Modified Response Evaluation Criteria in Solid Tumors (iRECIST).
The
initial evidence of progressive disease (PD) is to be confirmed by a second
assessment no less than 4 weeks from the date of the first documented
disease progression, in the absence of rapid clinical progression.
- - Progressive disease has been documented within 12 weeks from the last dose
of anti-PD-1/L1 mAb.
- - For patients treated with anti-PD-1/L1 mAb in the adjuvant setting:
- Has received at least 2 doses of an approved anti-PD-1/L1 mAb.
- - Develops recurrent disease during active adjuvant treatment with
anti-PD-1/L1 mAb, OR.
- - Develops recurrent disease within 6 weeks of last dose of anti-PD-1/L1 mAb.
- - Progressive disease is determined according to iRECIST (ie, progression by
Response Evaluation Criteria in Solid Tumors [RECIST] version [v]1.1 on first
imaging, confirmed with repeat imaging performed at least 4 weeks later).
Once
disease progression is confirmed, the initial date of disease progression
documentation will be considered the date of disease progression OR.
- - The determination of clinical progression is made by the investigator.
- - Participants whose disease harbors BRAF V600 mutation must have been exposed to
BRAF-targeted therapy, with BRAF-targeted treatment discontinued for either
progressive disease or intolerable toxicity.
- - The participant (or legally acceptable representative if applicable) provides written
informed consent for the trial.
- - Have measurable disease based on iRECIST.
Lesions situated in a previously irradiated
area are considered measurable if progression has been demonstrated in such lesions.
- - Have provided archival tumor tissue sample or newly obtained (within 3 months of
enrollment) core or excisional biopsy of a tumor lesion not previously irradiated.
Formalin-fixed, paraffin embedded (FFPE) tissue blocks are preferred to slides. Newly
obtained biopsies are preferred to archived tissue.
- - Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
Evaluation of ECOG is to be performed within 7 days prior to the first dose of study
intervention.
- - White blood cell (WBC) >= 3,000/uL.
(Laboratory values must be collected within 10
days prior to the start of study intervention [ie, first dose of study treatment]).
- - Absolute neutrophil count (ANC) >= 1,500/uL.
(Laboratory values must be collected
within 10 days prior to the start of study intervention [ie, first dose of study
treatment]).
- - Platelets >= 75,000/uL.
(Laboratory values must be collected within 10 days prior to
the start of study intervention [ie, first dose of study treatment]).
- - Hemoglobin >= 9 g/dL or >= 5.6 mmol/L.
(Laboratory values must be collected within 10
days prior to the start of study intervention [ie, first dose of study treatment]).
* Criterion must be met without erythropoietin dependency and without packed red blood
cell (pRBC) transfusion within last 2 weeks.
- - Serum creatinine =< 1.5 x upper limit of normal (ULN) OR measured or calculated
creatinine clearance >= 30 mL/min for subject with creatinine levels > 1.5 x
institutional ULN (glomerular filtration rate [GFR] can also be used in place of
creatinine or creatinine clearance [CrCl]).
(Laboratory values must be collected
within 10 days prior to the start of study intervention [ie, first dose of study
treatment]).
- - Serum total bilirubin =< 1.5 X ULN OR =< 3.0 mg/dL for patients with Gilbert syndrome.
(Laboratory values must be collected within 10 days prior to the start of study
intervention [ie, first dose of study treatment]).
- - Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and
alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) =< 2.5 X
ULN for subjects without liver metastases OR =< 5 X ULN for subjects with liver
metastases.
(Laboratory values must be collected within 10 days prior to the start of
study intervention [ie, first dose of study treatment]).
- - International normalized ration (INR) OR prothrombin time (PT) =< 1.5 x ULN unless
participant is receiving anticoagulant therapy as long as PT or activated partial
thromboplastin time (aPTT) is within therapeutic range of intended use of
anticoagulants.
(Laboratory values must be collected within 10 days prior to the start
of study intervention [ie, first dose of study treatment]).
- - Activated partial thromboplastin time (aPTT) =< 1.5 x ULN unless participant is
receiving anticoagulant therapy as long as PT or aPTT is within therapeutic range of
intended use of anticoagulants.
(Laboratory values must be collected within 10 days
prior to the start of study intervention [ie, first dose of study treatment]).
- - Urinalysis negative for hematuria with negative blood and 0 red blood cells (RBCs)
(Laboratory values must be collected within 10 days prior to the start of study
intervention [ie, first dose of study treatment]).
Exclusion Criteria:
- - Has a diagnosis of primary uveal or mucosal melanoma.
- - A WOCBP who has a positive urine pregnancy test within 72 hours of the first dose of
study intervention.
If the urine test is positive or cannot be confirmed as negative,
a serum pregnancy test will be required. In the event that 72 hours have elapsed
between the screening pregnancy test and the first dose of study treatment, another
pregnancy test (urine or serum) must be performed and must be negative in order for
subject to start receiving study medication. Pregnancy testing will be obtained every
three months while on study treatment; patients will be withdrawn from the study if
pregnancy occurs.
- - Has received prior systemic anti-cancer therapy including investigational agents
within 4 weeks (for immunotherapeutic agents) or within 2 weeks (for targeted
therapeutics) prior to the first dose of study drug.
If a subject has experienced
adverse events (AE) from prior treatment, he/she must have recovered from all AEs to <
grade 1 or baseline. Patients with < grade 2 neuropathy may be eligible. Patients with
endocrine-related AEs < 2 requiring treatment or physiologic steroid replacement may
be eligible.
- - Has received prior radiotherapy within 2 weeks of the first dose of study drug.
Participants must have recovered from all radiation-related toxicities, not require
corticosteroids, and not have had radiation pneumonitis. A 1-week washout is permitted
for palliative radiation (=< 2 weeks of radiotherapy) to non-central nervous system
(CNS) disease.
- - If participant has had recent major surgery, the participant must has recovered
adequately from the procedure and/or any complications from the surgery prior to the
first dose of study drug.
- - Has received a live vaccine or live-attenuated vaccine within 30 days prior to the
first dose of study drug.
Administration of killed vaccines is allowed.
- - Is currently participating in or has participated in a study of an investigational
agent or has used an investigational device within 4 weeks prior to the first dose of
study drug.
Participants who have entered the follow-up phase of an investigational
study may participate as long as it has been 4 weeks after the last dose of the
previous investigational agent.
- - Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy
(in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of
immunosuppressive therapy within 7 days prior to the first dose of study drug.
- - Has a known additional malignancy that is progressing or has required active treatment
within the past 2 years.
Participants with non-melanoma skin cancer (eg, basal cell
carcinoma of the skin, squamous cell carcinoma of the skin) or carcinoma in situ (eg,
breast carcinoma, cervical cancer in situ) that have undergone potentially curative
therapy are not excluded.
- - Subjects with untreated active central nervous system (CNS) metastases, active brain
metastases or leptomeningeal metastatic foci.
For the subjects with brain metastases,
if they have received treatment and have no evidence of progressive disease on
magnetic resonance imaging (MRI) at least 4 weeks after completion of the treatment
and within 30 days prior to the first dose, they are eligible to participate in the
study.
- - Has a history of severe hypersensitivity (>= grade 3), specifically infusion reaction
or anaphylaxis to pembrolizumab and/or any of its excipients.
- - Has a history of severe hypersensitivity (>= grade 3 reactions including wheezing,
rash, or hypotension) to rigosertib and/or any of its excipients (including
polyethylene glycol), or anaphylaxis.
- - Has active autoimmune disease that has required systemic treatment in the past 2 years
(i.e. with use of disease modifying agents, corticosteroids or immunosuppressive
drugs).
Replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid
replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a
form of systemic treatment and is allowed.
- - Has a history of (non-infectious) pneumonitis/interstitial lung disease that required
steroids or has current pneumonitis/interstitial lung disease.
- - Has an active infection requiring systemic therapy.
- - Has a known history of hepatitis B (defined as hepatitis B surface antigen [HBsAg]
reactive) or known active hepatitis C virus (defined as HCV ribonucleic acid [RNA]
[qualitative] is detected) infection.
Note: no testing for hepatitis B and hepatitis C
is required unless mandated by local health authority.
- - Has a known history of testing positive for human immunodeficiency virus (HIV) or
known acquired immunodeficiency syndrome (AIDS).
- - Has a history or current evidence of any condition, therapy, or laboratory abnormality
that might confound the results of the study, interfere with the participant's
participation for the full duration of the study, or is not in the best interest of
the participant to participate, in the opinion of the treating investigator.
- - Has known psychiatric or substance abuse disorders that would interfere with
cooperation with the requirements of the trial.
- - Is pregnant or breastfeeding or expecting to conceive or father children within the
projected duration of the study, starting with the screening visit through 120 days
after the last dose of trial treatment.
- - Has had an allogenic tissue/solid organ transplant.
