RegoMel

Inclusiecriteria: U mag meedoen als

1. ≥ 18 years of age.
2. Signed written informed consent.
3. Histologically confirmed advanced melanoma that is either stage III (unresectable) or stage IV (metastatic, unresectable)
4. Subjects must have failed prior systemic treatment with immune checkpoint inhibitors, including CTLA-4 blocking immune checkpoint inhibitors (ipilimumab or other experimental anti-CTLA-4 antibodies), and PD-1 blocking immune checkpoint inhibitors (pembrolizumab, nivolumab or other experimental anti-PD-1 antibodies). Progression of disease per RECIST, version 1.1 (Eisenhauer et al. Eur J Cancer 2009) or per immune related response criteria (Wolchok et al, Clin Cancer Res 2009) must have been documented during this prior treatment. Patients with BRAFV600mutant melanoma must have failed treatment with a BRAF-(+/-MEK) inhibitor. Patients who are not able to undergo such treatment will be considered eligible if all other eligibility criteria are fulfilled.
5. The presence of at least one measurable lesion per RECIST, version 1.1 (Eisenhauer et al. Eur J Cancer 2009)
6. Interval between the date of the last administration of prior therapy for melanoma and the date of recruitment:
a. ≥ 12 weeks following the date of the first administration and ≥ 3 weeks following the date of the last administration of an anti-CTLA-4-, PD-1- or PD-L1 blocking immune checkpoint inhibitor;
b. ≥ 4 weeks following the date of the last administration of chemotherapy (≥ 6 weeks in case of a nitrosurea or mitomycin C containing regimen);
c. > 14 days following the date of the last administration of targeted therapy with BRAF/MEK-inhibition.
7. All prior anti-cancer treatment-related toxicities (except alopecia and laboratory values as listed on Table 1) and non-medical treatments (e.g. surgery and radiation therapy) must be ≤ Grade 1 severity according to the Common Terminology Criteria for Adverse Events version 5 (CTCAE version 5.0; National Cancer Institute (NCI) 2017) at the time of enrollment.
8. The patient must be able to swallow and retain oral medication and must not have any clinically significant gastrointestinal abnormalities that may alter absorption such as malabsorption syndrome or major resection of the stomach or bowels.
9. Women of childbearing potential must have a negative serum pregnancy test within 14 days prior to recruitment and agree to use effective contraception throughout the treatment period, and for 16 weeks after the last dose of study treatment.
10. Men with a female partner of childbearing potential must have either had a prior vasectomy or agree to use effective contraception from 14 days prior to administration of the first dose of study treatment, throughout the treatment period, and for 16 weeks after the last dose of study treatment.
11. An Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2 (Oken et al, Am J Clin Oncol 1982).
12. Adequate baseline organ function as defined in Table 1.
13. Negative proteinuria on dipstick or 24 hours proteinuria

Exclusiecriteria: U mag niet meedoen als

- Subjects with uveal melanoma.
- Subjects with clinically active brain Metastase Meer informatie over de term "Metastase" Metastase (of uitzaaiing) is de verspreiding van tumorcellen vanuit de oorspronkelijke locatie (de primaire locatie) naar een ander deel van het lichaam. Tumoren kunnen metastaseren (uitzaaien) door nabijgelegen weefsel binnen te dringen of door zich te verspreiden via de circulatie (bloed en lymfestelsel). s (lesions should be stable and have been definitely treated with stereotactic radiation therapy, surgery or gamma knife therapy with no evidence of disease progression prior to enrollment).
- Any contra-indication for evaluation by whole body 18F-FDG-PET/CT or MRI of the brain.
- History of another malignancy. Exception: subjects who have been disease-free for 3 years, (i.e. subjects with second malignancies that are indolent or definitively treated at least 3 years ago) or subjects with a history of completely resected non-melanoma skin cancer.
- Current use of any prohibited medication.
- Taken an investigational drug within 28 days or 5 half-lives (minimum 14 days), whichever is shorter, prior to recruitment.
- Subjects with uveal melanoma.
- Subjects with clinically active brain Metastase Meer informatie over de term "Metastase" Metastase (of uitzaaiing) is de verspreiding van tumorcellen vanuit de oorspronkelijke locatie (de primaire locatie) naar een ander deel van het lichaam. Tumoren kunnen metastaseren (uitzaaien) door nabijgelegen weefsel binnen te dringen of door zich te verspreiden via de circulatie (bloed en lymfestelsel). s (lesions should be stable and have been definitely treated with stereotactic radiation therapy, surgery or gamma knife therapy with no evidence of disease progression prior to enrollment).
- Any contra-indication for evaluation by whole body 18F-FDG-PET/CT or MRI of the brain.
- History of another malignancy. Exception: subjects who have been disease-free for 3 years, (i.e. subjects with second malignancies that are indolent or definitively treated at least 3 years ago) or subjects with a history of completely resected non-melanoma skin cancer.
- Current use of any prohibited medication.
- Taken an investigational drug within 28 days or 5 half-lives (minimum 14 days), whichever is shorter, prior to recruitment.
- Any serious or unstable pre-existing medical conditions (aside from malignancy exceptions specified above), psychiatric disorders, or other conditions that could interfere with the subject’s safety, obtaining informed consent, or compliance with study procedures.
- Known HIV, HBV or HCV infection. Exception: subjects with laboratory evidence of cleared HBV and HCV infection will be permitted.
- Ongoing infection CTCAE v5.0 Grade > 2 requiring systemic therapy.
- No enzyme inducing anticonvulsants for ≥ 4 weeks prior to recruitment
- A history or evidence of cardiovascular risk including any of the following:
a.Current LVEF < LLN
b.A QT interval corrected for heart rate using the Bazett’s formula (QTcB) ≥ 480 msec;
c.A history or evidence of current clinically significant uncontrolled arrhythmias. Exception: subjects with atrial fibrillation controlled for > 30 days prior to recruitment are eligible.
d. A history (within 6 months prior to recruitment) of acute coronary syndromes (including myocardial infarction or unstable angina), or coronary angioplasty;
e.History of deep venous or arterial thrombosis, or CVA the last 6 months
f.A history or evidence of current ≥ Class II congestive heart failure as defined by the New York Heart Association (NYHA) guidelines;
g.Treatment refractory hypertension defined as a blood pressure of systolic >140 mmHg and/or diastolic > 90 mm Hg which cannot be controlled by antihypertensive therapy;
h.Patients with intra-cardiac defibrillators or permanent pacemakers;
i.Abnormal cardiac valve morphology (≥ grade 2; moderate valvular thickening) documented by echocardiogram (subjects with grade 1 abnormalities [i.e., mild regurgitation/stenosis] can be entered on study).
- Known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to the study treatments, their excipients, and/or dimethyl su

lfoxide (DMSO).
- Female patients who are nursing.

• UZ Brussel