RNA vaccine shows promise in advanced melanoma trial

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Cohort I: stage IV malignant melanoma (American joint committee on cancer (AJCC) 2009 melanoma classification) * Cohorts II-VII and expanded cohorts: stage IIIB-C, or stage IV of malignant melanoma (AJCC 2009 melanoma classification) \[only applicable until approval of protocol version 10.0\] Expanded cohort C only patients with stage IV melanoma (AJCC 2009 melanoma classification) with measurable disease (at least one target lesion according irRECIST) \[applicable for all patients included after approval of protocol version 10.0 and higher\] and with disease progression at the time of first treatment with Investigational medicinal product (IMP) \[applicable for all patients included after approval of protocol version 11.0\] * Therapy only for subjects not eligible or declining any other available approved therapy after all available treatment options have been transparently disclosed (to be documented!) * Expression of either NY-ESO-1, tyrosinase, MAGE-A3, and/or TPTE confirmed by RT-qPCR analysis from formalin-fixed paraffin-embedded (FFPE) * ≥ 18 years of age * Written informed consent * Eastern cooperative oncology group (ECOG) performance status (PS) 0-1 * Life expectancy ≥ 6 months * White blood cell (WBC) ≥ 3x10\^9/L * Hemoglobin ≥ 9 g/dL * Platelet count ≥ 100,000/mm\^3 * Alanine aminotransferase/Aspartate aminotransferase (ALT/AST) \< 3 x upper limit of normal (ULN) (except patients with liver metastasis) * Negative pregnancy test (measured by Human chorionic gonadotropin \[β-HCG\]) for females with childbearing age Exclusion Criteria: * Pregnancy or breastfeeding * Primary ocular melanoma * Concurrence of a second malignancy other than squamous or basal cell carcinoma, non-active prostate cancer, or cervical carcinoma in situ or non-active treated urothelial carcinoma * Brain metastases * Patients with history of treated or inactive brain metastasis are eligible for treatment in expanded cohort C, provided they meet all of the following criteria: * measurable disease outside of the brain (in addition to inactive brain metastasis); * no ongoing requirement of corticosteroids as therapy for brain metastases, * with corticosteroids discontinued ≥1 week prior to visit 2 (day 1) with no ongoing symptoms attributable to brain metastasis; * the screening brain radiographic imaging is ≥ 4 weeks since completion of radiotherapy * Post-splenectomy Patients * Known hypersensitivity to the active substance or to any of the excipients * A serious local infection (e.g. cellulitis, abscess) or systemic infection (e.g. pneumonia, septicemia) which requires systemic antibiotic treatment within 2 weeks prior to the first dose of study medication * Positive test for acute or chronic active hepatitis B or C infection * Clinically relevant active autoimmune disease * Systemic immune suppression: * Human immunodeficiency virus (HIV) disease * Use of chronic oral or systemic steroid medication (topical or inhalational steroids are permitted) * Other clinical relevant systemic immune suppression * Symptomatic congestive heart failure (NYHA 3 or 4) * Unstable angina pectoris * Radiotherapy and minor surgery within 14 days prior to the first study treatment administration * Myelosuppressive chemotherapy within 14 days and after reconstitution of blood values prior to the first study treatment administration * Ipilimumab within 28 days prior to the first study treatment administration * Treatments with BRAF inhibitors, MEK inhibitors, or the combination of both, and anti-programmed death-1 (PD-1) antibodies within 14 days prior to the first administration of study treatment (not applicable for patients with parallel treatment in expanded cohorts A, B, or C at the discretion of the investigator) * Interferon, major surgery, vaccination, and other investigational agents within 28 days or 5 half-lives depending on what gives the longer range before the first treatment * Approved BRAF inhibitors vemurafenib or dabrafenib, approved anti-PD-1 inhibitors nivolumab or pembrolizumab as well as approved MEK inhibitor trametinib, or the approved combination of BRAF-MEK inhibitors in patients in dose escalation cohorts. Concomitant treatment with approved BRAF inhibitors, approved anti-PD-1 antibodies or MEK inhibitor as well as the approved combination of BRAF-MEK inhibitors is allowed for patients included in the expanded cohorts, after analysis of safety data collected for the dose escalation cohorts and data and safety monitoring board (DSMB) approval. Local radiation will be allowed as concurrent treatment for patients in expanded cohort as well. \- After approval of protocol version 10.0 and higher only anti-PD-1 antibodies are allowed for treatment of patients in expanded cohort C. * Fertile males and females who are unwilling to use a highly effective method of birth control (less than 1% per year, e.g. condom with spermicide, diaphragm with spermicide, birth control pills, injections, patches or intrauterine device) during study treatment and for at least 28 days (male patients) and 90 days (female patients of childbearing potential) after the last dose of study treatment * Presence of a severe concurrent illness or other condition (e.g. psychological, family, sociological, or geographical circumstances) that does not permit adequate follow-up and compliance with the protocol