A Study of Fotemustine(FTM) Vs FTM and Ipilimumab (IPI) or IPI and Nivolumab in Melanoma Brain Metastasis

Inclusion Criteria:

• Willing and able to give written informed consent.

• Histologic diagnosis of malignant melanoma;

• Stage IV melanoma;

• No prior therapy for advanced (unresectable Stage III or Stage IV) disease;

• No previous systemic corticosteroid therapy within 7 days;

• Prior adjuvant treatment with IFN or other immunotherapy allowed with exception ofanti-CTLA-4;

• Presence of asymptomatic brain metastases: patients must have measurable metastases inthe brain, defined as lesions that can be accurately measured in 2 dimensions as ≥ 0.5cm (maximum 2 cm) in the brain MRI with contrast;

• Pts who have been previously treated with brain stereotactic radiotherapy (SRT),whole-brain radiotherapy (WBRT) and/or surgery, must have developed new measurablebrain lesions;

• Life expectancy ≥ 12 weeks;

• ECOG performance status of 0 or 1 (see Appendix 2);

• Normal laboratory tests were required.

• Subjects must have known BRAF V600E mutation status or consent to BRAF V600E mutationtesting per local institutional standard.

• Negative screening tests for HIV, Hepatitis B, and Hepatitis C.

• Men and women, of and over 18 years old.Women of childbearing potential (WOCBP) mustuse appropriate method(s) of contraception. WOCBP should use an adequate method toavoid pregnancy for 23 weeks (30 days plus the time required for nivolumab to undergofive half-lives) after the last dose of investigational drug

Exclusion Criteria:

• Any malignancy from which the patient has been disease-free for less than 5 years,with the exception of adequately treated and cured basal or squamous cell skin cancer,superficial bladder cancer, carcinoma in situ of the cervix;

• Primary ocular or mucosal melanoma. Medical History and Concurrent Diseases:

• Symptomatic brain metastases requiring immediate local intervention (radiotherapy (RT)and/or surgery);

• Autoimmune disease

• Any underlying medical condition, which in the opinion of the investigator, will makethe administration of study drug hazardous or obscure the interpretation of adverseevents, such as a condition associated with frequent diarrhea. Prohibited Treatments and/or Therapies:

• Concomitant therapy with any anti-cancer agent; immunosuppressive agents; anynon-oncology vaccine therapy used for prevention of infectious diseases (for up to 1month prior to or after any dose of study drug); surgery or radiotherapy ; otherinvestigational anti-cancer therapies; or chronic use of systemic corticosteroids

• Previous treatment with other investigational products, including cancerimmunotherapy, within 30 days;

• Prior treatment with anti-CTLA-4 and/or , anti-PD1/PD-L1 or fotemustine. Sex and Reproductive Status:

• WOCBP who are unwilling or unable to use an acceptable method to avoid pregnancy forthe entire study period and for up to 8 weeks after the study;

• Women who are pregnant or breastfeeding;

• Women with a positive pregnancy test on enrollment or prior to investigational productadministration;

• Sexually active fertile men not using effective birth control if their partners areWOCBP. Other Exclusion Criteria:

• Prisoners or subjects who are involuntarily incarcerated;

• Subjects who are compulsorily detained for treatment of either a psychiatric orphysical illness.