Propranolol Hydrochloride and Pembrolizumab in Treating Patients With Stage IIIC-IV Melanoma That Cannot Be Removed by Surgery

Inclusion Criteria:

• Participants must be newly diagnosed, treatment-naive with histologically confirmedstage IIIC unresectable melanoma or stage IV melanoma

• Have an Eastern Cooperative Oncology Group (ECOG) performance status 0-1

• Available archival formalin-fixed paraffin-embedded (FFPE) from a prior biopsy or,participant must be willing to have a tissue biopsy taken at a clinic visit prior tostart of study treatment

• Have measurable disease per irRECIST v1.1

• Ability to swallow and retain oral medication

• Absolute neutrophil count (ANC) >= 1500/uL

• Hemoglobin (Hb) >= 9 g/dL

• Platelet count >= 100, 000/uL

• Total bilirubin =< 1.5 x ULN (upper limit of normal) - unless patient has Gilbert'ssyndrome

• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2 x ULN

• If the patient has liver metastasis AST and ALT less than or greater to 5x ULN

• Serum or plasma (based on site's SOP) creatinine < 2 x ULN

• Participants of child-bearing potential must have a negative pregnancy test at studyentry and then agree to use adequate contraceptive methods (e.g., hormonal orbarrier method of birth control; abstinence) prior to study entry; should a womanbecome pregnant or suspect she is pregnant while she or her partner is participatingin this study, she should inform her treating physician immediately

• Participant must understand the investigational nature of this study and sign anIndependent Ethics Committee/Institutional Review Board approved written informedconsent form prior to receiving any study related procedure

Exclusion Criteria:

• Participants who have received previous immunotherapy for any cancer (excludingmelanoma) including PD-1/PD-L1 inhibitors but not interferons and CTLA-4 inhibitors

• Participants with chronic autoimmune diseases

• Participants that are already on non-selective B-AR blockers for variousindications. Patients on selective beta-blockers are considered eligible forenrollment with a caveat that their clinician prescribing the beta-blocker iswilling to discontinue their selective beta-blocker in order to transition topropranolol at the specified protocol dose.

• Participants with symptomatic known brain metastases < 4 weeks from radiationtreatment should be excluded from this clinical trial

• Other invasive cancers diagnosed < 3 years back that required systemic treatment. Ifdiagnosed with other invasive cancer >=3 years, should have complete recovery fromall systemic toxicity except neuropathy and alopecia

• Uncontrolled intercurrent illness including, but not limited to, ongoing or activeinfection, symptomatic congestive heart failure, unstable angina pectoris, cardiacarrhythmia, or psychiatric illness/social situations that would limit compliancewith study requirements

• Pregnant or nursing female participants, where pregnancy is defined as the state ofa female after conception and until the termination of gestation, confirmed by apositive human chorionic gonadotropin (hCG) laboratory test

• Unwilling or unable to follow protocol requirements

• Any condition which in the investigator's opinion deems the participant anunsuitable candidate to receive study drug

• Other active non-melanoma metastatic cancers

• Contraindications to the use of beta-blockers, like, uncontrolled depression,unstable angina pectoris, uncontrolled heart failure (grade III or IV), hypotension (systolic blood pressure < 100 mmHg), bradycardia (resting heart rate <55bpm),severe asthma or chronic obstructive pulmonary disease (COPD), uncontrolled type Ior type II diabetes mellitus (glycosylated hemoglobin [HbA1C] > 8.5 or fastingplasma glucose > 160 mg/dl at screening), symptomatic peripheral arterial disease orRaynaud's syndrome, untreated pheochromocytoma, current use or past use in the lasttwo years of non-selective beta-blockers or non-dihydropyridine calcium channelblockers. Patients on selective beta blockers will be eligible for enrollment onlyunder the condition that their prescribing clinician is willing to discontinue theirselective beta blocker in order to begin propranolol and only at the specified dose (after which time the patient is not to be started on any non-selectivebeta-blockers or non-dihydropyridine calcium channel blockers)

• Patient is currently receiving or has received systemic corticosteroids (=< 2 weeksprior to starting study drug, or who have not fully recovered from side effects ofsuch treatment)

• Diagnosis of immunodeficiency or receiving systemic steroid therapy or any otherform of immunosuppressive therapy within 14 days prior to the first dose of thestudy drug

• Has received a live vaccine or live-attenuated vaccine within 30 days prior to thefirst dose of trial treatment and while participating in the trial. Examples of livevaccines include, but are not limited to, the following: measles, mumps, rubella,varicella/zoster, yellow fever, rabies, BCG, and typhoid vaccine. Administration ofkilled vaccines is allowed.