Proof of Concept of TBio-4101, Lymphodepleting Chemo, IL-2 for Relapsed/Refractory Melanoma

Inclusion Criteria:

• Participants must have histologically confirmed, unresectable or metastatic melanomaas follows:

• Cutaneous, non-acral, melanoma (including melanoma of unknown primary)

• Cutaneous acral melanoma

• Mucosal melanoma

• Ocular melanoma (including uveal, iris, conjunctival melanoma)

• Participants must have failed, be refractory to, or unable to tolerate standard ofcare in the opinion of the Investigator. For participants with cutaneous non-acralmelanoma, standard of care therapy includes a PD-1/L1 inhibitor, a CTLA-4 inhibitor,and if BRAF V600 activating mutation positive, a BRAF ± MEK inhibitor.

Note: if treatment failure occurs during adjuvant therapy or within 6 months of adjuvant therapy completion, this will count as a failure of the applicable regimen as noted above.

• Any systemic therapy, including anti-cancer monoclonal antibodies, must have beencompleted at least 4 weeks from the start of lymphodepleting therapy (except forbridging therapy as defined below), and any prior therapy-related AEs must haveresolved to Grade ≤ 1 except for alopecia and vitiligo. Neuropathy must haveresolved to Grade ≤ 2.

• Participants must be between the ages of 18 and 75 years old. Additionally,participants who are ≥ 60 years of age must undergo a cardiology evaluationincluding a cardiac stress test after which they must be deemed to be low/acceptablerisk.

• ECOG performance status of 0 or 1

• Participants must have adequate organ and marrow function as defined below:

1. Absolute neutrophil count ≥ 1,500/mcL (non-growth factor supported)

2. Platelet count ≥ 100,000/mcL

3. Hemoglobin ≥ 8.0 g/dL

4. AST (SGOT)/ALT (SGPT) ≤ 3 times the institutional ULN; ≤ 5 times ULN if patienthas liver metastasis

5. Cockcroft-Gault estimated GFR ≥ 50 mL/min (creatinine)

6. Total bilirubin ≤ 2.0 mg/dL (except in patients with Gilbert's Syndrome wherethe bilirubin must be ≤ 3 mg/dL)

• Seronegative for Human immunodeficiency virus (HIV) antibody, hepatitis B surfaceantigen, and hepatitis C (HCV) antibody (if HCV antibody positive, must be testedfor HCV RNA, which must be negative to be eligible)

• Participants with brain metastases are eligible provided that the brain metastaseshave been successfully treated with stereotactic radiosurgery or resection andclinically stable for at least 1 month.

• Participants who have not undergone prior TIL harvest (i.e., the patient was notenrolled in the Banked TIL protocol MCC# <TBD>) must have at least 1 cm of tumoramenable for resection for TIL generation, in addition to, having at least onetarget lesion that can be used for response assessment by RECIST 1.1 criteria afterTIL harvest.

• Participants who have undergone prior TIL harvest with the banking protocol (MCC# <TBD>) must have adequate numbers of cryopreserved TIL after the pre-REP to meetcriteria for proceeding with TBio-4101 therapy.

• Participants must be willing and able to undergo an apheresis procedure

• Women of child-bearing potential must have a negative pregnancy test

• The effects of TBio-4101 on the developing human fetus are unknown. For this reasonand because TIL agents, as well as other therapeutic agents used in this trialincluding IL-2 are known to be teratogenic, both males and females of child-bearingpotential must be willing to practice birth control starting with screening through 1 year after the last study drug is administered for females or 6 months for males.Note: Women of child-bearing potential must have a negative serum pregnancy test.

• Contraception requirement:

• To prevent pregnancy, patients who are able to conceive or father children must usea highly effective contraception method during sexual activity starting withScreening through 1 year after the last study drug is administered for females or 6months for males.

Based on their mechanisms of action, the NMA-LD chemotherapy, aldesleukin (IL-2), can cause fetal harm when administered to a pregnant woman. Effects of TBio-4101 on fetal development are unknown.

• Definition of Non-Reproductive Potential: For this trial, male patients will beconsidered to be of non-reproductive potential if they have azoospermia (whether dueto having had a vasectomy or due to an underlying medical condition). Femalepatients will be considered of non-reproductive potential if they are either: (a)postmenopausal (defined as at least 12 months with no menses without an alternativemedical cause; in women < 45 years of age, a high follicle stimulating hormone (FSH)level in the postmenopausal range may be used to confirm a post-menopausal state inwomen not using hormonal contraception or hormonal replacement therapy. In theabsence of 12 months of amenorrhea, a single follicle FSHH measurement isinsufficient); (b) Or have had a hysterectomy and/or bilateral oophorectomy,bilateral salpingectomy or bilateral tubal ligation/occlusion, at least 6 weeksprior to screening; (c) Or has a congenital or acquired condition that preventschildbearing.

• Definition of Highly Effective Contraception: The following are examples ofacceptable contraception methods to prevent pregnancy. This list may not becomprehensive for all regions, so the Investigator must discuss sexual activity andcontraception usage with the patient. Hormonal contraceptive: oral contraceptivepill (estrogen/progestin pill or progestin-only pill), contraceptive skin patch,vaginal contraceptive ring, or subcutaneous contraceptive injection, Intrauterinedevice (IUD), Intrauterine hormone releasing system (IUS), Bilateral tubalocclusion, Vasectomized partner.

• Should a woman become pregnant or suspect she is pregnant while she or her partnerare participating in this study, she should inform her treating physicianimmediately.

• Ability to understand and the willingness to sign a written informed consentdocument.

Exclusion Criteria:

• Participants, regardless of age, who have a current or past medical history ofischemic heart disease, or clinically significant atrial or ventricular rhythmabnormality are excluded unless they undergo a cardiac stress test and cardiologyclearance examination and are determined to be low or acceptable risk.

Note: Participants with any clinically significant cardiac wall movement abnormality are excluded.

• Participants who have received prior cell therapy.

• Participants with either a primary immunodeficiency disorder (i.e., severe combinedimmunodeficiency syndrome) or acquired immunodeficiency disorders (such as HIV/AIDS)

• Pregnant women are excluded from this study because the agents used in this studyhave teratogenic or abortifacient effects. Because there is an unknown but potentialrisk for adverse events in nursing infants secondary to treatment of the mother withTBio-4101 or the other agents in the study, breastfeeding should be discontinued ifthe mother is enrolled in the study.

• Participants taking systemic steroid therapy (other than replacement therapy) ortherapy with any immunosuppressive medications such as mycophenolate mofetil (MMF).Participants who require dapsone for pneumocystis pneumonia (PCP) prophylaxis duringTIL therapy are eligible.

• Participants who have a history of severe immediate hypersensitivity reaction to thestudy agents including cyclophosphamide, fludarabine, or aldesleukin/ IL-2 or any oftheir constituents

• Participants with a left ventricular ejection fraction (LVEF) ≤ 45% or New YorkHeart Association (NYHA) functional classification > 1

• Forced expiratory volume (FEV1) ≤ 60% of predicted value and DLCO (corrected) < 60%of predicted value

• Participants who, in the opinion of the Investigator, have a medical condition thatwould subject the patient to prohibitive risk by participation in this study, or whomay be unable to safely complete the apheresis, tumor harvest, lymphodepletionregimen, TIL infusion, or aldesleukin/ IL-2 administration

• Participants with active infections requiring parenteral antibiotics

• Participants with autoimmune disease currently or within the past 6 months requiringsystemic treatment with immunosuppressive doses of corticosteroids (>10 mg ofprednisone-equivalent daily dosing), immunosuppressive biologic agents, or diseasemodifying antirheumatic drug agents (DMARDs).

Note: Participants with autoimmune thyroiditis on replacement thyroid medication are eligible.

• Participants requiring chronic anti-coagulant therapy that cannot either bediscontinued or changed to an anti-coagulant such as a low molecular weight heparin,which has a relatively short half-life, if clinically indicated during the period ofthrombocytopenia resulting from the lymphodepletion regimen

• Has evidence of impeding perforation, obstruction or bleeding (requiringtransfusion) due to the tumor.