Pilot Ipilimumab in Stage IV Melanoma Receiving Palliative Radiation Therapy

Inclusion Criteria:

   1. Signed Written Informed Consent

   Before any study procedures are performed, subjects (or their legally acceptable
   representatives) will have the details of the study described to them, and they will
   be given a written informed consent document to read. Then, if subjects consent to
   participate in the study, they will indicate that consent by signing and dating the
   informed consent document in the presence of study personnel.

   2. Target Population

      - Histologically confirmed Stage IV melanoma.

      - Must have failed at least one systemic therapy for malignant melanoma or be
      intolerant to at least one prior systemic treatment.

      - Subjects with asymptomatic brain metastases are eligible. (Systemic steroids
      should be avoided if possible, or the subject should be stable on the lowest
      clinically effective dose, as steroids as they may interfere with the activity of
      ipilimumab if administered at the time of the first ipilimumab dose.)

      - Primary ocular and mucosal melanomas are allowed.

      - Must be at least 28 days since treatment with chemotherapy, biochemotherapy,
      surgery, radiation, or immunotherapy, and recovered from any clinically
      significant toxicity experienced during treatment.

      - Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2.

      - Life expectancy of ≥ 16 weeks.

      - Subjects must have baseline (screening/baseline) radiographic images, (e.g.
      brain, chest, abdomen, pelvis, and bone scans with specific imaging tests to be
      determined by the attending physician) within 6 weeks of initiation of
      ipilimumab.

      - Required values for initial laboratory tests:

         - White blood cell (WBC) ≥ 2000/uL (~ 2 x 10^9/L)

         - Absolute neutrophil count (ANC) ≥ 1000/uL (~ 1 x 10^9/L)

         - Platelets ≥ 75 x 10^3/uL (~ 75 x 10^9/L)

         - Hemoglobin ≥ 9 g/dL (~ 80 g/L; may be transfused)

         - Creatinine ~ 2 x upper limit of normal (ULN)

         - Aspartate aminotransferase (AST) / alanine aminotransferase (ALT) ~ 2.5 x
         ULN for subjects without liver metastasis ~ 5 times for liver metastases

      - Bilirubin: ~ 2.0 x ULN (except for subjects with Gilbert's Syndrome, who must
      have a total bilirubin of < 3.0 mg/dL)

      - No active or chronic infection with HIV, Hepatitis B, or Hepatitis C.

      - Two or more measurable sites of disease (≥ 1.5 cm) which include the disease site
      that requires palliative radiation therapy as well as ≥ 1 other disease site
      outside of the planned radiation therapy field.

   3. Age and Sex

      - Men and women, at least 18 years of age.

      - Women of childbearing potential (WOCBP) must be using an adequate method of
      contraception to avoid pregnancy throughout the study [and for up to 26 weeks
      after the last dose of investigational product] in such a manner that the risk of
      pregnancy is minimized.

      - WOCBP include any female who has experienced menarche and who has undergone
      successful surgical sterilization (hysterectomy, bilateral tubal ligation, or
      bilateral oophorectomy) or is not postmenopausal. Post-menopausal is defined as:

         - Amenorrhea ≥ 12 consecutive months without another cause, or

         - For women with irregular menstrual periods and on hormone replacement
         therapy (HRT), a documented serum follicle stimulating hormone (FSH) level >
         35 mIU/mL

      - Women who are using oral contraceptives, other hormonal contraceptives (vaginal
      products, skin patches, or implanted or injectable products), or mechanical
      products such as an intrauterine device or barrier methods (diaphragm, condoms,
      spermicides) to prevent pregnancy, or are practicing abstinence or where their
      partner is sterile (eg, vasectomy) should be considered to be of childbearing
      potential. WOCBP must have a negative serum or urine pregnancy test (minimum
      sensitivity 25 IU/L or equivalent units of HCG) within 72 hours prior to the
      start of investigational product.

      c) Men of fathering potential must be using an adequate method of contraception
      to avoid conception throughout the study [and for up to 26 weeks after the last
      dose of investigational product] in such a manner that the risk of pregnancy is
      minimized.

Exclusion Criteria:

   1. Sex and Reproductive Status

      - WOCBP who are unwilling or unable to use an acceptable method to avoid pregnancy
      for the entire study and for up to 8 weeks after the last dose of investigational
      product.

      - WOCBP using a prohibited contraceptive method.

      - Women who are pregnant or breastfeeding.

      - Women with a positive pregnancy test on enrollment or before investigational
      product administration.

   2. Target Disease Exceptions

      - Subjects on any other systemic therapy for cancer, including any other
      experimental treatment.

      - Prior treatment with an anti-CTLA-4 antibody if treatment failure was due to
      adverse events (AEs). If a subject was discontinued from the prior anti-CTLA-4
      treatment due to an AE or serious adverse event (SAE), regardless of the type of
      event, that discontinuation constitutes an exclusion criterion. If AEs were
      serious enough to require a subject's withdrawal from prior treatment, the
      subject should be excluded from this study.

      - A history of AEs with prior IL-2 or Interferon will not preclude subjects from
      entering the current study.

      - Subjects who relapsed in study MDX010-16 are not eligible for this study.

   3. Medical History and Concurrent Diseases

      - Autoimmune disease: subjects with a documented history of inflammatory bowel
      disease, including ulcerative colitis and Crohn's disease are excluded from this
      study as are subjects with a history of symptomatic disease (eg, rheumatoid
      arthritis, systemic progressive sclerosis [scleroderma]; systemic lupus
      erythematosus (SLE); autoimmune vasculitis [eg, Wegener's Granulomatosis]).
      Subjects with motor neuropathy considered of autoimmune origin (eg,
      Guillain-Barre Syndrome and Myasthenia Gravis) are excluded from this study.

      - Any subject who has a life-threatening condition that requires high-dose
      immunosuppressant(s)

      - Presence of known Hepatitis B or Hepatitis C infection, regardless of control on
      antiviral therapy

      - Subjects with melanoma who have another active, concurrent, malignant disease are
      not eligible for the CA184045 study, with the exception of subjects with
      adequately treated basal or squamous cell skin cancer, superficial bladder
      cancer, or carcinoma in situ of the cervix.

   4. Medical History and Concurrent Diseases

      - Prisoners or subjects who are involuntarily incarcerated.

      - Subjects who are compulsorily detained for treatment of either a psychiatric or
      physical (eg, infectious disease) illness.

      - Any underlying medical or psychiatric condition that, in the opinion of the
      investigator, could make the administration of ipilimumab hazardous or could
      obscure the interpretation of adverse events.

      - Any non-oncology vaccine therapy used for prevention of infectious diseases for
      up to 4 weeks before or after any dose of ipilimumab, with the exceptions of
      amantadine and flumadine.

      - Central nervous system (CNS) metastases that require palliative radiation
      therapy; prior brain irradiation is allowed providing CNS disease is stable.

   5. Additional Concomitant Treatments

      - Any investigational agents

      - Any other (non-CA184045 related) CTLA-4 inhibitors or agonists

      - CD137 agonists

      - Immunosuppressive agents (unless required for treating potential AEs)

      - Chronic systemic corticosteroids (unless required for treating treatment emergent
      AEs or required for management of signs or symptoms due to brain metastases, upon
      discussion with BMS medical monitor).

Eligibility criteria for this study have been carefully considered to ensure the safety of
the study subjects and to ensure that the results of the study can be used. It is
imperative that subjects fully meet all eligibility criteria.