Inclusion Criteria:
- Adults 18 years of age or older.
- For US sites: Histopathologically confirmed melanoma with an injectable cutaneous or
lymph node metastasis that has progressed in the opinion of the treating investigator
despite administering a Food and Drug Administration (FDA) approved anti-PD1 agent,
with or without ipilimumab.
- For European sites: Histopathologically confirmed melanoma with an injectable
cutaneous or lymph node metastasis that has progressed in the opinion of the treating
investigator despite administering a regulatory approved anti-PD1 agent, with or
without ipilimumab.
- Eastern Cooperative Oncology Group (ECOG) performance status 0 to 1.
- Measurable disease according to RECIST 1.1.
- Acceptable coagulation status: international normalised ratio (INR) of blood clotting,
prothrombin time and activated partial thromboplastin time within ≤1.5 x upper limit
of normal (ULN).
- Completion of local therapy, such as radiation, surgical resection, injectable
immunebased therapy, or topical pro-inflammatory agent, 21 days prior to first dose of
protocol therapy.
- Adverse events from previous cancer therapies (excluding alopecia) must have recovered
to grade 1 (CTCAE, most recent version). Stable grade 2 AEs such as endocrine
conditions are allowed, and other chronic stable AEs may be considered on a case by
case basis by the Principal Investigator.
- Clinical stability of brain metastases for at least 4 weeks prior to first day of
study therapy.
- Acceptable liver and renal functions defined as:
- Total bilirubin ≤1.5 x ULN (does not include patients with Gilbert's Disease)
- Aspartate aminotransferase (AST, SGOT), alanine aminotransferase (ALT, SGPT) ≤3.0
x ULN
- Serum creatinine ≤1.5 x ULN
- Acceptable haematological function defined as (Patients can be transfused to meet the
haemoglobin entry criteria):
- Haemoglobin ≥9 g/dL
- Neutrophils ≥1.5 x 10^9/L
- Platelet count ≥75 x 10^9/L
- Able to provide valid written informed consent.
- All women of childbearing potential must have a negative urine or serum pregnancy test
at screening.
- For US sites: All patients must agree to use barrier contraception (i.e. condom)
during study treatment and for 2 months after the last virus treatment and 4 months
after the last dose of chemotherapy and pembrolizumab.
- For European sites: All patients must agree to use highly effective contraception for
at least 6 months (according to the latest country specific SmPC) after administration
of CPO, up to 4 months after last dose of pembrolizumab, and up to 2 months after last
dose of ONCOS-102, whichever comes last.
- For European sites: All women of child-bearing potential must agree to perform
pregnancy testing throughout the study starting at baseline, every 3 weeks from day 22
until last dose of study medication (ONCOS-102 and pembrolizumab) and then every month
for at least 6 months.
Exclusion Criteria:
- A concomitant medical condition requiring receipt of a therapeutic anticoagulant that
in the opinion of the treating physician cannot safely allow for therapeutic injection
of ONCOS-102 and tumor biopsies. Local clinical practice can be followed with regard
to holding a therapeutic anticoagulant during invasive procedures such as biopsies.
- A concomitant medical condition that in the opinion of the treating physician would
pose unreasonable additional risk to therapeutic injection of ONCOS-102.
- For US sites: Receipt of Investigational agents within 28 days prior to first dose of
protocol therapy.
- For European sites: Current participation or participation in a study of an
investigational agent within 28 days prior to first dose of protocol therapy. Note:
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.
- Any symptomatic autoimmune disease (such as lupus, scleroderma, Crohn's disease,
ulcerative colitis) that requires administration of >10mg of prednisone equivalent.
Lower dose steroids for conditions such as hypophysitis are allowed.
- Any prior severe adverse event attributed to prior anti-PD1 therapy that, in the
Principal investigator's opinion, would contraindicate pembrolizumab administration
such as:
- Grade 2 or higher pneumonitis
- Grade 4 AST or ALT elevation
- Grade 3 or higher colitis attributable to PD1 blockade; note that colitis
attributable to ipilimumab is not excluded
- Note: in the absence of clinical symptoms of pancreatitis, elevations of amylase
or lipase are not contraindications to therapy on this trial
- Known active infection with Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), or HIV.
Cleared HBV/HCV infection is not an exclusion, nor is HIV infection with cluster of
differentiations 4 (CD4) counts >500 and an undetectable viral load.
- Active bacterial, viral, or fungal infections, requiring systemic therapy apart from
anti-viral maintenance therapy for HIV.
- History of organ transplant.
- Patients requiring chronic systemic immunosuppressants, including steroids (prednisone
daily equivalent of >10 mg).
- Brain metastases that are clinically unstable (e.g. showing unequivocal growth on
imaging, requiring radiation therapy, or steroids >10mg of prednisone equivalent)
within 4 weeks of first dose of study drug.
- Known severe congenital or acquired cellular or humoral immunodeficiency such as
common variable immunodeficiency.
- For US sites: Women who are pregnant or breast-feeding currently or are planning to
conceive during or up to 4 months after end of protocol therapy.
- For European sites: Women who are currently pregnant or breast-feeding or are planning
to conceive during or up to 6 months after end of protocol therapy.
