Neoadjuvant Nivolumab and Relatlimab in Cutaneous Squamous Cell Carcinoma

Inclusion Criteria:

1. ≥ 18 years of age

2. Written informed consent

3. Histologically confirmed, resectable stage II to IV cutaneous squamous cellcarcinoma defined as: Non-head and neck cuSCC:

4. stage II (T2, N0, M0)

5. stage III (T3, N0, M0; or T1-3, N1, M0)

6. stage IV (T1-3, N2 or N3, M0; or T4a or T4b, any N, M0) Cutaneous head and neck CC:

7. stage II (T2, N0, M0)

8. stage III (T3, N0, M0)

9. stage IV (T4a or T4b, any N, M0)

10. In-transit metastases (ITM) are permitted if they are completely resectable. ITMdefined as skin or subcutaneous metastases that are > 20 mm from the primary lesionbut not beyond the regional nodal basin.

11. Measurable disease according to RECIST version 1.1 criteria (≥10 mm longest diameterfor primary lesions and / or ≥15 mm in shortest diameter for lymph nodes asdetermined by CT imaging) within 2 weeks of the start of study treatment.

12. Tumour amenable to a newly obtained core biopsy of a lesion which has not beenpreviously irradiated. Archival tissue from a past primary or nodal cuSCC lesion (ifapplicable) or tissue taken for current diagnosis will also be collected.

13. Previous radiotherapy permitted if performed at a prior site of disease not seen atbaseline.

14. Eastern Cooperative Oncology Group (ECOG) performance status of 0-1

15. Documented adequate haematological, hepatic, renal, and thyroid function determinedby blood pathology

16. Anticipated life expectancy of > 12 months

17. Women of childbearing potential must have a negative serum pregnancy test within 24hours of the first dose of study treatment or within 72 hours if this is notfeasible. Effective contraception should be used for the duration of study treatmentand for 5 half-lives (or 5 months) after the last dose. Egg donation (ova, oocytes)should be avoided for the same period. There are no partner-pregnancy or spermdonation avoidance requirements for male patients.

Exclusion Criteria:

1. Clinical or radiographic evidence of distant metastasis

2. SCC of the eyelid, vulva, penis and perianus

3. Any contraindication to the administration of nivolumab and / or relatlimab

4. Prior anti-PD-1, CTLA-4 (Cytotoxic T-lymphocyte associated protein 4), PDL-1 (Programmed death-ligand 1) or LAG 3 (Lymphocyte-Activation Gene 3) antibodyexposure, or an agent directed to another stimulatory or co-inhibitory T-cellreceptor for any disease or any chemotherapy or experimental local or systemic drugtreatment

5. Active autoimmune disease or a requirement for chronic steroid therapy other thanhormone replacement therapy The following are permitted:

• Vitiligo

• Type I diabetes mellitus on stable insulin therapy

• Residual autoimmune hypothyroidism on stable hormone replacement

• Resolved childhood asthma or atopy

• Psoriasis not requiring systemic treatment

• Autoimmune conditions which are not expected to recur in the absence of anexternal trigger.

6. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in doses exceeding 10 mg daily of prednisone or equivalent) or any other form ofimmunosuppressive therapy within 14 days prior to the first dose of study treatment. The following are permitted:

• Replacement therapy (e.g. thyroxine, insulin, or physiologic corticosteroidreplacement therapy for adrenal or pituitary insufficiency, etc.)

• Inhaled or intranasal corticosteroids (with minimal systemic absorption) may becontinued if patient is on a stable dose

• Non-absorbed intra-articular steroid injections.

7. Known additional malignancies (unless adequately treated) active within the previous 3 years, except for locally curable cancers that have been apparently cured. The following malignancies, if undergone successful definitive resection or curativetreatment, are permitted:

• Basal cell carcinoma of the skin

• Squamous cell carcinoma of the skin

• Carcinoma in situ (e.g. breast carcinoma, cervical cancer in situ, butexcluding carcinoma in situ of the bladder) that have undergone potentiallycurative therapy

• Prostatic intraepithelial neoplasia

• In situ melanoma

• Atypical melanocytic hyperplasia

• Multiple primary melanomas

• Other malignancies for which the patient has been disease free for 3 years, notrequiring active anti-cancer therapy.

8. Uncontrolled or significant cardiovascular disease including, but not limited to anyof the following:

• Myocardial infarction (MI) or stroke/transient ischemic attack within the 6months prior to consent

• Uncontrolled angina within the 3 months prior to consent

• Any history of clinically significant arrhythmias (such as poorly controlledatrial fibrillation, ventricular tachycardia, ventricular fibrillation, ortorsades de pointes)

• QTc (corrected QT interval) prolongation > 480 ms

• History of other clinically significant cardiovascular disease (i.e.cardiomyopathy, congestive heart failure with New York Heart Associationfunctional classification III-IV, pericarditis, significant pericardialeffusion, significant coronary stent occlusion, poorly controlled venousthrombosis, etc)

• Cardiovascular disease-related requirement for daily supplemental oxygen

• History of 2 or more M.I.s OR 2 or more coronary revascularisation procedures (regardless of the number of stent placements during each procedure)

• Patients with history of myocarditis, regardless of aetiology.

9. Troponin T (TnT) or I (TnI) >2 × institutional ULN (upper limit of normal).Participants with TnT or TnI levels between >1 to 2 × ULN will be permitted ifrepeat levels within 24 hours are ≤1 ULN. If TnT or TnI levels are between >1 to 2 ×ULN within 24 hours, the participant may undergo a cardiac consultation and beconsidered for treatment, following cardiologist recommendation. When repeat levelswithin 24 hours are not available, a repeat test should be conducted as soon aspossible. If TnT or TnI repeat levels beyond 24 hours are <2 × ULN, the participantmay undergo a cardiac consultation and be considered for treatment, followingcardiologist recommendation. Notification of the decision to enrol the participantfollowing cardiologist recommendation must be made to the Lead Investigator.

10. Has a history of (non-infectious) pneumonitis/interstitial lung disease thatrequired steroids or has current pneumonitis or current interstitial lung disease.

11. Has an active infection requiring systemic therapy.

12. Has had an allogenic tissue/solid organ transplant

13. Has a known history of Human Immunodeficiency Virus (HIV). Note: no testing for HIVis required unless mandated by local health authority.

14. Has a known history of Hepatitis B (defined as Hepatitis B surface antigen [HBsAg]reactive) or known active Hepatitis C virus (defined as HCV RNA [qualitative] isdetected) infection. Note: no testing for Hepatitis B and Hepatitis C is requiredunless mandated by local health authority.

15. Pregnant or breast-feeding females

16. Concurrent medical or social conditions that may prevent the patient from attendingassessments per schedule.