Clinical Trial Finder

Key

Inclusion Criteria:

• - Male or female who is 12 years of age or older at the time of signed informed consent.

• - Patients with histologically or cytologically confirmed unresectable or metastatic Stage IIIb through IV/M1a through M1d cutaneous melanoma.

• - Confirmed disease progression (PD) on an approved anti-PD-1 and an anti-CTLA-4 treatment, administered either as a combination regimen (eg, nivolumab + ipilimumab) or in sequence.

1. Treatment with prior anti-PD-1 therapy must have continued for a minimum of 8 weeks. 2. Patients who in the physician's judgement are not candidates for treatment with an anti-CTLA-4 antibody are eligible.

• - Has documented BRAF V600 mutation status.

Patients with BRAF mutation should have received prior BRAF-directed therapy (with or without a MEK inhibitor) prior to enrollment in the study, unless deemed not clinically indicated at Investigator's discretion due to concurrent medical condition or prior toxicity.

• - Has at least 1 measurable and injectable tumor of ≥1 cm in longest diameter (or shortest diameter for lymph nodes).

• - Has adequate hematologic function.

• - Has adequate hepatic function.

• - Has adequate renal function.

• - Prothrombin time (PT) ≤1.5 × ULN and partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT) ≤1.5 × ULN.

• - Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 to 1 for patients 18 years and older or a Lansky performance score (PSc) ≥80 for patients 12 to 17 years of age.

• - Life expectancy of at least 3 months.

• - Female and male patients of reproductive potential must agree to avoid becoming pregnant or impregnating a partner and adhere to highly effective contraception requirements during the treatment period and for at least 6 months after the last dose of study treatment.

• - Women of childbearing potential must have a negative serum beta-human chorionic gonadotropin (β-hCG) test within 72 hours before the first dose of study treatment.

Key

Exclusion Criteria:

• - Primary mucosal or uveal melanoma.

• - More than 2 lines of systemic therapy for advanced melanoma.

• - Known acute or chronic hepatitis.

• - Known human immunodeficiency virus (HIV) infection.

• - Active significant herpetic infections or prior complications of HSV-1 infection.

• - Had systemic infection requiring IV antibiotics or other serious active infection requiring antimicrobial, antiviral, or antifungal treatment within 14 days prior to dosing.

• - With active significant herpetic infections or prior complications of HSV-1 infection.

• - Evidence of spinal cord compression or at high risk of spinal cord compression.

• - Known active central nervous system (CNS) metastases and/or carcinomatous meningitis at time of screening.

• - Serum lactate dehydrogenase (LDH) >2 × ULN.

• - Major surgery ≤2 weeks prior to starting study drug.

• - Prior malignancy active within the previous 3 years, except for locally curable cancers that have apparently been cured.

• - History of significant cardiac disease including myocarditis or congestive heart.

• - History of life-threatening toxicity related to prior immune.

• - Active, known, or suspected autoimmune disease requiring systemic treatment.

• - History of (noninfectious) pneumonitis that required steroids or has current pneumonitis.

• - Prior oncolytic virus or other therapy given by intratumoral administration.

• - Requires intermittent or chronic use of systemic (oral or IV) antivirals with known antiherpetic activity (eg, acyclovir).

• - Has received a live vaccine within 28 days prior to the first dose of study treatment.

• - Systemic anticancer therapies within 5 half-lives or 4 weeks of the first dose, whichever is shorter.

• - Conditions requiring treatment with immunosuppressive doses (>10 mg per day of prednisone or equivalent) of systemic corticosteroids other than for corticosteroid replacement therapy within 14 days after enrollment.

Arms

Experimental: VO + nivolumab

Active Comparator: Physicians Choice

Choosing from 1 of the following (to be consistent with approved label and/or applicable local clinical guidelines): - Nivolumab + relatlimab (as Opdualag) - Anti-PD-1 monotherapy (nivolumab or pembrolizumab) - Single-agent chemotherapy (dacarbazine, temozolomide, or paclitaxel/albumin-bound paclitaxel)

Interventions

Biological: - Vusolimogene Oderparepvec

Genetically modified Herpes Simplex Type 1 Virus.

Biological: - Nivolumab

Anti-PD-1 Monoclonal Antibody

Biological: - Nivolumab + Relatlimab

Nivolumab: Anti-PD-1 Monoclonal antibody. Relatlimab: A lymphocyte activation gene-3 (LAG-3) blocking antibody.

Biological: - Pembrolizumab

A programmed death receptor-1 (PD-1)-blocking antibody indicated.

Drug: - Single-agent chemotherapy

Dacarbazine, temozolomide, or paclitaxel/albumin-bound paclitaxel.