Precision Radiation of Immune Checkpoint Therapy Resistant Melanoma Metastases

Exclusion Criteria

• •1. Inability to understand given information or undergo study procedures according to protocol
• •2. Pregnant or breast-feeding. Patients must agree to use safe contraception during and for 3 months after study treatment.
• •3. A condition requiring systemic treatment with either corticosteroids (\> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 30 days before start of study treatment. Inhaled or topical steroids and adrenal replacement doses \>10 mg daily prednisone equivalents are permitted.
• •4. Has an active infection requiring systemic therapy.
• •5. Concomitant therapy with any anti-tumor medications, other than PD-1/CTLA-4 inhibitors or 30 days before and after treatment in this trial.
• •6. Prior radiotherapy preventing the study intervention with precision radiotherapy
• •7. Location, size or number of metastases is deemed as excessive or not appropriate for precision radiotherapy
• •8. Central nervous system (CNS) metastases at baseline, with the exception of those subjects who have previously-treated CNS metastases (surgery ± radiotherapy, radiosurgery, or gamma knife) and who meet both of the following criteria: a) are asymptomatic and b) have no requirement for steroids or anticonvulsants.
• •9. Prior malignancy. Subjects who have had another malignancy should be disease-free for 5 years, or should have a history of completely resected non-melanomatous skin carcinoma or successfully treated in situ carcinoma