Binimetinib and Encorafenib for the Treatment of Metastatic Melanoma and Central Nervous System Metastases

Inclusion Criteria:

• Able to provide written informed consent.

• Age >= 18 years at the time of informed consent

• Histologically confirmed diagnosis of melanoma

• Presence of BRAFV600 mutation in tumor tissue previously determined by a local assay (including immunohistochemistry [IHC]) at any time prior to Screening or duringScreening

• Cohort A: BRAF V600 mutant melanoma patients with progressive central nervous system (CNS) metastases. This includes patients with parenchymal brain metastases and/orLMD

• Cohort A: Prior therapy with Food and Drug Administration (FDA)-approved BRAFinhibitors (+/- MEK inhibitors) is required

• No washout period is required

• Cohort A: Prior therapy with immunotherapy or other investigational agents isallowed

• Washout period of 14 days since last dose

• Cohort B: BRAF V600 mutant melanoma patients who are treatment naive to BRAF/MEKinhibitors with CNS metastases, including LMD. Prior treatment with immunotherapy ispermitted

• For patients with parenchymal brain metastases (mets) without LMD

• Metastatic disease to the brain with at least 1 progressing parenchymal brainlesion >= 0.5 cm and =< 3 cm, defined as a magnetic resonance imaging (MRI)contrast-enhancing lesion that may be accurately measured in at least 1dimension

• For patients with LMD

• Patients must have investigator assessed radiographic and/or CSF cytologicalevidence of LMD

• Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of =< 2

• Patients may receive steroids to control symptoms related to CNS involvement

• For patients with parenchymal brain metastases the dose must be =< 2 mg per 24hours of dexamethasone (or the equivalent). Patient's symptoms shouldexperience stability of neurological symptoms for at least 7 days, or ontapering dose of steroids. Physiologic replacement doses for adrenalinsufficiency is allowed on this protocol

• For patients with LMD: the dose must be =< 4 mg per 24 hours of dexamethasone (or the equivalent). Physiologic replacement doses for adrenal insufficiency isallowed on this protocol

• Radiation therapy:

• For patients with parenchymal brain mets: prior radiation therapy, includingstereotactic (SRS) or whole brain radiation (WBXRT) is allowed, but patientmust be progressing in or having at least 1 new CNS lesion. Prior SBRT toextracranial lesions is allowed. Washout to prior radiation 14 days.

• For patients with LMD: Patients who have received radiation to brain and/orspine, including WBXRT, SRS, or SBRT, are eligible, but must have completedradiation treatment at least 7 days prior to the start of treatment.

• Prior therapy with systemic immunotherapy or other investigational agents is allowed

• Washout period of 14 days since last dose

• Other cancer directed treatment:

• Concurrent treatment with other anti-cancer systemic therapies is not allowed.No other concomitant intrathecal therapy with another agent will be allowed.For patients that have received other systemic therapies, the minimum wash outperiod is as follows:

• Patients that received previous intrathecal therapy must have receivedtheir last treatment >= 7 days prior to the start of treatment

• Patients who have received systemic chemotherapy must have received theirlast treatment >= 21 days prior to the start of treatment

Patients must have appropriate laboratory parameters as defined below:

• Absolute neutrophil count (ANC) 1.5 X 10^9/L

• Hemoglobin 9.0 g/dL

• Platelets 75 X 10^9/L

• Prothrombin time (PT)/international normalized ratio (INR) and partialthromboplastin time (PTT) =< 1.5 X upper limit of normal (ULN)

• Total bilirubin =< 1.5 X ULN (isolated bilirubin > 1.5 X ULN is acceptable ifbilirubin is fractionated and direct bilirubin < 35%)

• NOTE: Patients with documented Gilbert syndrome or hyperbilirubinemia due tonon-hepatic cause (e.g., hemolysis, hematoma) may be enrolled followingdiscussion and agreement with the primary investigator

• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5 X ULN, inpatients with liver metastases ≤5 X ULN

• Albumin ≥2.5 g/dL

• Creatinine ≤ 1.5 X ULN OR calculated creatinine clearance ≥50 mL/min OR 24-hoururine creatinine clearance ≥50 mL/min

• Female patients of childbearing potential must have a negative serum and/or urinepregnancy test result

• Female patients of childbearing potential must agree to protocol-approved methods ofcontraception and to not donate ova from Screening until 30 days after the last doseof study drug. Male patients must agree to use methods of contraception that arehighly effective or acceptable and to not donate sperm from Screening until 90 daysafter the last dose of study drug

• The patient is deemed by the Investigator to have the initiative and means to complywith scheduled visits, treatment plan and study procedures

Exclusion Criteria:

• Evidence of active infection =< 7 days prior to initiation of study drug therapy (does not apply to viral infections that are presumed to be associated with theunderlying tumor type required for study entry)

• Use of non-oncology vaccines containing live virus for prevention of infectiousdiseases within 30 days of prior to study drug. Dead virus vaccines (e.g Flu) areallowed, even during treatment with study drug

• Inability to swallow and retain study treatment

• Known history of testing positive for human immunodeficiency virus (HIV) or knownacquired immunodeficiency syndrome (AIDS) even if fully immunocompetent onantiretroviral therapy (ART)

• Impaired cardiovascular function or clinically significant cardiovascular diseaseincluding, but not limited to, the following:

• History of acute coronary syndromes (including myocardial infarction, unstableangina, coronary artery bypass grafting, coronary angioplasty or stenting) < 6months prior to screening

• Congestive heart failure requiring treatment (New York Heart Association grade >= 2)

• A left ventricular ejection fraction (LVEF) < 50% as determined by multigatedacquisition (MUGA) or echocardiogram (ECHO)

• History or presence of clinically significant cardiac arrhythmias (includingresting bradycardia, uncontrolled atrial fibrillation or uncontrolledparoxysmal supraventricular tachycardia)

• Baseline Fridericia's correction formula (QTcF) interval >= 480 msec. Can berepeated up to three times to confirm

• Concurrent neuromuscular disorder (e.g., inflammatory myopathies, musculardystrophy, amyotrophic lateral sclerosis, spinal muscular atrophy)

• Impairment of gastrointestinal function or disease which may significantly alter theabsorption of study treatment (e.g., uncontrolled nausea, vomiting or diarrhea;malabsorption syndrome; small bowel resection). Known history of acute or chronicpancreatitis

• History or current evidence of retinal vein occlusion (RVO) or current risk factorsfor RVO (e.g., uncontrolled glaucoma or ocular hypertension, history ofhyperviscosity or hypercoagulability syndromes); history of retinal degenerativedisease

• Use of herbal supplements, medications or foods that are moderate or stronginhibitors or inducers of cytochrome P450 (CYP) 3A4/5 =< 1 week prior to the startof study treatment

• History of a thromboembolic event < 12 weeks prior to starting study treatment.Examples of thromboembolic events include transient ischemia attack, cerebrovascularaccident, deep vein thrombosis or pulmonary embolism. Catheter-related venousthrombosis is not considered a thromboembolic event for this trial even if < 12weeks prior to starting study treatment. Note: Patients with either deep veinthrombosis or pulmonary emboli that do not result in hemodynamic instability areallowed to enroll as long as they are stable, asymptomatic and on stableanticoagulants for at least 2 weeks. Additionally, patients with thromboembolicevents related to indwelling catheters or other procedures may be enrolled

• Evidence of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection

• NOTE: Patients with laboratory evidence of cleared HBV or HCV infection may beenrolled

• NOTE: Patients with no prior history of HBV infection who have been vaccinatedagainst HBV and who have a positive antibody against hepatitis B surfaceantigen as the only evidence of prior exposure may enroll

• Pregnancy or breastfeeding or patients who plan to become pregnant during theduration of the study

• Other severe, acute or chronic medical or psychiatric condition or laboratoryabnormality that may increase the risk associated with study participation or studytreatment administration or that may interfere with the interpretation of studyresults and, in the judgment of the Investigator, would make the patient aninappropriate candidate for the study