VO and Nivolumab vs Physician's Choice in Advanced Melanoma That Progressed on Anti-PD-1 & Anti-CTLA-4 Drugs (IGNYTE-3)

Eligibility Criteria

• * Male or female who is 12 years of age or older at the time of signed informed consent.
• * Patients with histologically or cytologically confirmed unresectable or metastatic Stage IIIb through IV/M1a through M1d cutaneous melanoma.
• * Confirmed disease progression (PD) on an approved anti-PD-1 and an anti-CTLA-4 treatment, administered either as a combination regimen (eg, nivolumab + ipilimumab) or in sequence.
• 1. Treatment with prior anti-PD-1 therapy must have continued for a minimum of 8 weeks
• 2. Patients who in the physician's judgement are not candidates for treatment with an anti-CTLA-4 antibody are eligible
• * Has documented BRAF V600 mutation status. Patients with BRAF mutation should have received prior BRAF-directed therapy (with or without a MEK inhibitor) prior to enrollment in the study, unless deemed not clinically indicated at Investigator's discretion due to concurrent medical condition or prior toxicity.
• * Has at least 1 measurable and injectable tumor of ≥1 cm in longest diameter (or shortest diameter for lymph nodes).
• * Has adequate hematologic function.
• * Has adequate hepatic function.
• * Has adequate renal function.
• * Prothrombin time (PT) ≤1.5 × ULN and partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT) ≤1.5 × ULN
• * Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 to 1 for patients 18 years and older or a Lansky performance score (PSc) ≥80 for patients 12 to 17 years of age.
• * Life expectancy of at least 3 months.
• * Female and male patients of reproductive potential must agree to avoid becoming pregnant or impregnating a partner and adhere to highly effective contraception requirements during the treatment period and for at least 6 months after the last dose of study treatment.
• * Women of childbearing potential must have a negative serum beta-human chorionic gonadotropin (β-hCG) test within 72 hours before the first dose of study treatment.
• * Primary mucosal or uveal melanoma.
• * More than 2 lines of systemic therapy for advanced melanoma.
• * Known acute or chronic hepatitis.
• * Known human immunodeficiency virus (HIV) infection.
• * Active significant herpetic infections or prior complications of HSV-1 infection.
• * Had systemic infection requiring IV antibiotics or other serious active infection requiring antimicrobial, antiviral, or antifungal treatment within 14 days prior to dosing.
• * With active significant herpetic infections or prior complications of HSV-1 infection.
• * Evidence of spinal cord compression or at high risk of spinal cord compression.
• * Known active central nervous system (CNS) metastases and/or carcinomatous meningitis at time of screening.
• * Serum lactate dehydrogenase (LDH) \>2 × ULN.
• * Major surgery ≤2 weeks prior to starting study drug.
• * Prior malignancy active within the previous 3 years, except for locally curable cancers that have apparently been cured
• * History of significant cardiac disease including myocarditis or congestive heart.
• * History of life-threatening toxicity related to prior immune.
• * Active, known, or suspected autoimmune disease requiring systemic treatment.
• * History of (noninfectious) pneumonitis that required steroids or has current pneumonitis.
• * Prior oncolytic virus or other therapy given by intratumoral administration.
• * Requires intermittent or chronic use of systemic (oral or IV) antivirals with known antiherpetic activity (eg, acyclovir).
• * Has received a live vaccine within 28 days prior to the first dose of study treatment.
• * Systemic anticancer therapies within 5 half-lives or 4 weeks of the first dose, whichever is shorter.
• * Conditions requiring treatment with immunosuppressive doses (\>10 mg per day of prednisone or equivalent) of systemic corticosteroids other than for corticosteroid replacement therapy within 14 days after enrollment.