This is an open-label, phase 1, first-in-human (FIH), dose-escalation, multicenter, multinational trial evaluating the safety of oncolytic adenovirus TILT-123 as monotherapy and in association with T-cell therapy with TILs in metastatic melanoma patients.

The primary objective of the trial is to evaluate the safety of TILT-123. The approach has the potential to a) increase the efficacy of adoptive T-cell therapy, b) remove the need for toxic pre- and post-conditioning regimens, c) yield the combined anti-tumor benefits of armed oncolytic viruses and T-cell therapy.

Dose escalation of TILT-123 injection will take place between cohorts not intra-patient and will be determined based on Dose Limiting Toxicities (DLTs).

Inclusion Criteria:

• Signed and dated informed consent before any trial-related activities.
• Male or female, between 18-75 years of age (both included).
• Pathologically confirmed previously treated refractory or recurrent stage 3-4 melanoma, which cannot be treated with curative intent with available therapies.
• At least one prior line of medical treatment is required (for example checkpoint inhibitors, kinase inhibitors, interleukin-2). Multiple prior therapies (e.g. surgery, checkpoint inhibitors, kinase inhibitors, interleukin-2, interferon, chemotherapy, radiation) are allowed.
• A > 9 mm tumor (in diameter, typically a minimum of 1 cm3 in volume) without signs of necrosis must be available for biopsy/operation to enable growing of TILs.
• At least one additional tumor (>14 mm in diameter) must be available for injections and biopsies for correlative analyses. The disease burden must be measurable, but does not need to fulfil RECIST 1.1.
• Eligible for adoptive T-cell therapy with tumor infiltrating lymphocytes

Adequate hepatic, cardiac and renal functions as following:

1. Platelets > 75 000/mm3

2. Haemoglobin ≥ 100 g/L.

3. AST and ALT < 3 x ULN.

4. GFR >60 ml/min (Cockcroft-Gault formula).

5. Leukocytes (WBC) > 3,0

6. Bilirubin <1.5 x ULN

   • Men and women must be willing to use adequate forms of contraception from screening, during the trial, and for a minimum of 90 days after end of treatment, in accordance with the following:
   • Women of childbearing potential: Barrier contraceptive method (i.e. condom) must be used in addition to one of the following methods: Intrauterine devices or hormonal contraception (oral contraceptive pills, implants, transdermal patches, vaginal rings or long-acting injections).
   • Women not of childbearing potential: Barrier contraceptive method (i.e. condom) must be used.
   • Men: Barrier contraceptive method (i.e. condom) must be used.
   • Demonstrated WHO performance score of 0-1 at screening.
   • Life expectancy time longer than 3 months.
   • Capable of understanding and complying with parameters as outlined in the protocol.
   • BRAF negative or positive.

Exclusion Criteria:

• Use of immunosuppressive medications (corticosteroids or drugs used in treatment of autoimmune disease). Exempted are the following which can be allowed at screening and during the trial: replacement corticosteroids if e.g. the patient has adrenal insufficiency after prior immunotherapy; pulmonal and topical treatments; up to 20 mg of prednisone/prednisolone.
• History of another active invasive cancer as judged by the investigator within the past 3 years except basalioma.
• Treated with any anti-cancer therapy for melanoma 30 days prior to enrolment. Anti-cancer therapy for melanoma is defined as anti-cancer agents (immunotherapy, signal-transduction inhibitors [e.g. BRAF and MEK inhibitors], cytotoxic chemotherapy), radiotherapy and investigational agents. An investigational agent is any drug or therapy that is currently not approved for use in humans.
• Uncontrolled cardiac or vascular diseases.
• History of heart attack or cerebral stroke within the previous 12 months before screening or is not recovered from an older heart attack or cerebral stroke.
• LDH value > 3 x ULN.
• History of hepatic dysfunction, hepatitis or HIV.
• History of coagulation disorder.
• Any other disease which prevent participation in the opinion of the investigator.
• Female patients who are pregnant, breastfeeding or intends to become pregnant.
• Untreated brain metastases. Treated brain metastases which have not progressed in 3 months prior to screening are allowed.
• Previously treated with any oncolytic adenovirus that was administered intratumorally.
• Previously treated with adoptive cell therapy.
• Allergy to TILT-123, TIL, or ingredients present in the investigational medicinal products.
• Administered an investigational medicinal product or device in another clinical trial within 30 days prior to screening