Clinical Trials

Inclusion Criteria:

• Male or female patients at least 18 years of age at the time of signing the informed consent form (ICF).
• Histologically confirmed diagnosis of unresectable stage IIIB D, or unresectable stage IV malignant melanoma.
• Eligible for combination treatment with nivolumab and ipilimumab.
• An ECOG performance status of 0 or 1.
• Adequate organ function as indicated by the following laboratory values:
• Absolute neutrophil count ≥ 1,500/µL;
• Platelet count ≥ 100 x 10^3/µL;
• Hemoglobin ≥ 9 g/dL or ≥ 5.6 mmol/L;
• Serum creatinine ≤ 1.5 x upper limit of normal (ULN).;
• Serum total bilirubin ≤ 1.5 x ULN or direct bilirubin ≤ ULN for patients with total bilirubin levels > 1.5 ULN;
• Aspartate aminotransferase/serum glutamic oxaloacetic transaminase and alanine aminotransferase/serum glutamic pyruvic transaminase ≤ 2.5 x ULN for patients without liver metastasis or ≤ 5 x ULN for patients with liver metastasis.
• Male patients who are sexually active with a female of childbearing potential must agree to use an adequate method of contraception.
• Women of childbearing potential (WOCBP) must have a negative urine or serum pregnancy test.
• WOCBP must use adequate contraception.

Exclusion Criteria:

• Previous non melanoma malignancies unless curatively treated and complete remission was achieved at least 2 years prior to randomization. Patients with prior curatively treated basal or squamous cell carcinoma of the skin, carcinoma in situ of the cervix, or carcinoma in situ of the breast, or other in situ cancers are allowed irrespective of time passed since curative treatment. Patients with prior completely resected malignant melanoma are also allowed.
• Known brain metastases or leptomeningeal metastases. If a patient experiences neurological symptoms indicative of brain metastases, a brain MRI should be performed.
• Diagnosis of uveal or ocular melanoma.
• Known history or any evidence of active, non-infectious pneumonitis.
• History of New York Heart Association class 3-4 congestive heart failure or history of myocardial infarction within 6 months of starting induction therapy.
• Active infection requiring systemic treatment.
• Diagnosis of immunodeficiency. 
• Known history of severe hypersensitivity reactions to nivolumab, ipilimumab, sargramostim, or their excipients.
• Known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies).
• History of or active hepatitis B (hepatitis B surface antigen reactive) or active hepatitis C (hepatitis C virus antibody).
• Women who are breastfeeding.
• Prior systemic treatment for unresectable stage IIIB D or unresectable stage IV malignant melanoma.
• Systemic corticosteroid treatment (doses exceeding 10 mg daily of prednisone or equivalent) or any other form of immunosuppressive treatment within 7 days prior to the first dose of induction therapy.
• Receipt of a live vaccine within 30 days prior to start of induction therapy.
• Receipt of any other investigational treatment within 4 weeks of the first dose of induction therapy.