4SC-202 in Combination With Pembrolizumab in Patients Primary Refractory/Non-responding to Prior Anti-PD-1 Therapy

• 4SC-202 in combination with Pembrolizumab (Drug): 4SC-202 in combination with Pembrolizumab

Primary outcomes

• Incidence of Adverse Events [Safety and Tolerability] [Up to 114 weeks]: Safety and tolerability of the combination of 4SC-202 and Pembrolizumab will be assessed from adverse events.

Secondary outcomes

• Objective Response Rate (ORR) [Up to 102 weeks]: The Objective Response Rate (ORR) will be defined as the percentage of patients who have achieved a confirmed response of at least Immune-related Complete Response (irCR) or Immune-related Partial Response (irPR)
• Best Overall Response (BOR) [Up to 102 weeks]: The Best Overall Response defined as the best among all confirmed overall responses (irCR is better than irPR is better than irSD)
• Disease Control Rate (DCR) [Up to 102 weeks]: The Disease Control Rate (DCR) will be defined as the percentage of patients who have achieved a confirmed response of at least irCR or irPR or a response of irSD
• Duration of Response (DOR) [Up to 102 weeks]: Duration of response (DOR) is defined as the time from the first documentation of response to the date of disease progression. Patients who have no documented disease progression at the end of the study or who are lost to follow-up or who receive additional anti-neoplastic therapy after discontinuing 4SC-202 and Pembrolizumab will be censored at the date of their last extent of disease assessment or on the first date of additional therapy, respectively.
• Progression Free Survival (PFS) [Up to 102 weeks]: The time from first dosing (C1D1) to date of first observed progression or death from any cause (whichever comes first). Patients who have not progressed while on study and have not died while on study will be censored at the last evaluable assessment date.
• Time to Progression (TTP) [Up to 102 weeks]: The time from first dosing (C1D1) to first date of first observed progression. Patients who have not progressed while on study, have not died while on study or experienced a non-disease- related death will be censored at the last evaluable assessment date.
• Overall Survival (OS) [Up to 102 weeks]: The Overall Survival (OS) is defined as the time from first dosing (C1D1) to date of death from any cause. Patients who have not died while on study will be censored at the last evaluable assessment date

Sex: All, ages: 18 Years to any

Main Inclusion Criteria:

* Patients with unresectable stage III or stage IV cutaneous melanoma, as per American Joint Committee on Cancer (AJCC) (Version 8) staging system (must have been histologically confirmed at least once during course of disease). Patients with metastatic tumor of unknown primary site and histology of melanoma are eligible.
* Patients must be primary refractory or non-responding to anti-PD-1 therapy (either as monotherapy or in combination with Ipilimumab)
* Measurable disease by computer tomography (CT) or Magnetic resonance imaging (MRI) per immune-related response evaluation criteria in solid tumors (irRECIST) 1.1 criteria, with longest diameter for non-nodal lesions ≥ 10 mm and ≥ 15 mm in short axis for nodal lesions
* At least one tumor site (either primary site or metastasis) must be accessible for sequential biopsies and patient must consent to the 2 mandatory biopsies. This requirement is not applicable for continuous dosing schedules and may be waived by the sponsor in other individual cases.

Main Exclusion Criteria:

* Patients who achieved a CR or PR, during or after prior anti-PD-1 mono- or anti-CTLA-4/anti-PD-1 combination therapy
* Patients with symptomatic brain metastases/central nervous system (CNS) involvement
* Patients with inadequate organ function
* Therapy with agents known to prolong the QT interval and increase the risk for Torsades de Pointes

• Dirk Schadendorf, MD, Principal investigator, Universitätsklinikum Essen