Neoadjuvant PD-1 Inhibitor Dostarlimab (TSR-042) Vs. Combination of Tim-3 Inhibitor Cobolimab (TSR-022) and PD-1 Inhibitor Dostarlimab (TSR-042) in Melanoma

Inclusion Criteria:

• written informed consent for the study

• ≥ 18 years of age

• histologically or cytologically confirmed diagnosis of cutaneous or unknown primarymelanoma (excluding uveal/choroidal and mucosal melanoma; although acral melanoma isincluded) belonging to one of the following AJCC 8th edition TNM stages:

1. Tx or T1-4 AND

2. N1b, or N1c, or N2b, or N2c, or N3b, or N3c AND/OR

3. M1a or M1b

Patients are eligible for this trial either at presentation for primary melanoma with concurrent regional nodal and/or in-transit metastasis and/or oligometastasis; AND/OR at the time of clinical detected nodal and/or in-transit and/or oligometastatic recurrence; and may belong to any of the following groups:

Primary melanoma with clinically apparent regional lymph node metastases; Clinically detected recurrent melanoma at the proximal regional lymph node(s) basin; Clinically detected primary melanoma involving multiple regional nodal groups; Clinical detected nodal melanoma (if single site) arising from an unknown primary; In-transit and/or satellite metastases with or without regional lymph node involvement; Distant skin and/or in-transit and/or satellite metastases with or without regional lymph node involvement; Oligometastatic lung disease with or without regional lymph node involved permitted if deemed resectable at baseline NOTE: Determination of resectability must be made at baseline to be eligible for this neoadjuvant study.

• measurable disease based on RECIST 1.1

• must provide tumor tissue from a newly obtained core, punch, incisional orexcisional tumor biopsy

• 0 or 1 on the ECOG Performance Scale

• Demonstrate adequate organ function on screening labs obtained within 14 days ofregistration

• negative serum pregnancy test (females of childbearing potential)

• females of non-childbearing potential must be ≥45 years of age and has not hadmenses for >1 year; if amenorrhoeic for <2 years without history of a hysterectomyand oophorectomy must have an FSH value in the postmenopausal range;post-hysterectomy, post-bilateral oophorectomy, or post-tubal ligation (documentedhysterectomy or oophorectomy)

• male subjects should agree to use an adequate method of contraception

Exclusion Criteria:

• Patients with uveal and/or mucosal melanoma histology are excluded (Patients withmelanoma of unknown histology are permitted to enroll after discussion withPrincipal Investigator)

• Is currently participating in or has participated in a study of an investigationalagent or using an investigational device within 4 weeks of the first dose oftreatment.

• Is receiving systemic immunosuppression with either corticosteroids (>10mg dailyprednisone equivalent) or other immunosuppressive medications) for active autoimmunedisease: history of active autoimmune disease requiring systemic treatment withinthe past 3 months or a documented history of clinically severe autoimmune disease,or a syndrome that requires systemic steroids (>10mg daily prednisone or equivalent)or systemic immunosuppressive agents

• ≥ CTCAE grade 3 immune-related AE (irAE) experienced with prior immunotherapy (except, non-clinically significant lab abnormalities (elevations in lipase, amylasenot associated with clinically significant disease etc.) even if ≥ CTCAE grade 3 mayenroll if resolved at this time, or, development of autoimmune disorders of Grade ≤ 3 may enroll if the disorder has resolved to Grade ≤ 1)

• received prior chemotherapy, targeted small molecule therapy, or radiation therapywithin 2 weeks prior to study Day 1 or who has not recovered (i.e., ≤ Grade 1 or atbaseline) from adverse events due to a previously administered agent (except ≤ Grade 2 neuropathy)

• autoimmune disorders of Grade 4 while on prior immunotherapy

• active (i.e., symptomatic or growing) central nervous system (CNS) and/orleptomeningeal metastases (CNS lesions that are treated and deemed stable (repeatimaging study done at least 2 weeks prior to first dose of study treatment) are NOTpermitted to enroll even if other inclusion criteria are met and patients areneurologically asymptomatic)

• known additional malignancy that is progressing or requires active treatment (except, basal cell carcinoma of the skin, squamous cell carcinoma of the skin, orin situ cervical cancer that has undergone potentially curative therapy)

• invasive cancer diagnosed and treated less than 2 years prior to currentpresentation (other indolent malignancies that are not progressing and/or deemed torequire active therapy are not exclusionary)

• evidence of interstitial lung disease or active, non-infectious pneumonitis

• active infection requiring systemic therapy

• history or current evidence of any condition, therapy, or laboratory abnormalitydetermined to be significant, in the opinion of the treating investigator

• known psychiatric or substance abuse disorders that would interfere with studycompliance

• is pregnant or breastfeeding, or expecting to conceive or father children within theprojected duration of the trial

• had a live vaccine within 30 days of initiating protocol therapy

• received prior therapy with an IDO inhibitor, anti-PD-1, anti-PD-L1, anti-PD-L2,anti-CD137 and/or combination (including nivolumab, pembrolizumab oripilimumab/nivolumab). Prior treatment with ipilimumab or interferon alfa isallowed.

• history of allergic or hypersensitivity reaction to components or excipients ofDostarlimab (TSR-042) and TSR-022, interferon alfa or ipilimumab

• known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).

• known history of or screening test that is positive for hepatitis B virus (HBV; eg,HBsAg reactive or HBV DNA detected) or hepatitis C virus (HCV; HCV antibody positiveand/or HCV RNA quantitative is detected). Hepatitis C antibody - positive subjectswho received and completed treatment for hepatitis C that was intended to eradicatethe virus may participate if hepatitis C RNA levels are undetectable. Hepatitis Bpositive subjects who received and completed treatment for hepatitis B that wasintended to eradicate the virus may participate if hepatitis B DNA levels areundetectable.