Nivolumab With Ipilimumab in Subjects With Neuroendocrine Tumors

Inclusion Criteria:

- Subjects with histologically confirmed advanced, progressive, well-differentiated
nonfunctional NET of the pancreas, lung or gastrointestinal (GI) tract per the 7th
International Association for the Study of Lung Cancer classification (IASLC) or the
American Joint Committee on Cancer (AJCC) Staging Handbook, 7th edition.

- Measurable disease by CT or MRI per RECIST 1.1 criteria (Appendix 3);
radiographic tumor assessment performed within 28 days before treatment. Target
lesions may be located in a previously irradiated field if there is documented
(radiographic) disease progression in that site after the completion of radiation
therapy.

- Prior therapy, including everolimus, octreotide, surgery, chemoradiation, is all
permitted after being properly noted. This prior therapy must have been completed
at least 28 days prior to study enrollment.

- Previously untreated patients who decline standard therapy for their cancer are
allowed to enroll.

- Subjects are to have tumor tissue sample available at central lab for PD -L1 IHC
testing during the screening period. Subjects can initiate therapy before the
result of IHC testing. The tumor tissue sample must be a core needle biopsy,
excisional or incisional biopsy. It may be fresh or archival if obtained within 6
months prior to enrollment, and there can have been no systemic therapy (e.g.,
adjuvant or neoadjuvant chemotherapy) given after the sample was obtained.

- (Stage 2 only) Subjects must be willing to undergo 2 sets of core needle biopsies
(pre-treatment and at 6-8 weeks on therapy) if there are lesions amenable to
biopsy. Subjects without a lesion amendable to biopsy will still be permitted to
enroll provided they have an archival tumor sample for PD-L1 IHC testing. An
optional core biopsy will be requested at progression.

- ECOG performance status ≤ 1 (see Appendix 1)

- Prior palliative radiotherapy to non-CNS lesions must have been completed at
least 2 weeks prior to treatment. Subjects with symptomatic tumor lesions at
baseline that may require palliative radiotherapy within 4 weeks of first
treatment are strongly encouraged to receive palliative radiotherapy prior to
treatment.

- Patients must have normal organ and marrow function as defined below:

- - WBC ≥1,500/mcL

- - absolute neutrophil count ≥1,000/mcL

- - hemoglobin ≥ 8.0 g/dL

- - platelets ≥75,000/mcL

- - total bilirubin ≤ 1.5 x ULN (patients with Gilbert's syndrome may have serum
bilirubin ≤ 3 x ULN)

- - AST/ALT ≤ 3 × institutional ULN (≤ 5 x ULN in the presence of liver metastases)

- creatinine

- ≤ 1.5 × ULN or creatinine clearance (CrCl) ≥ 40 mL/min (if using the Cockcroft-Gault
formula below):

- Female:

- CrCl = (140 - age in years) x weight in kg x 0.85

o 72 x serum creatinine in mg/dL

- Male:

- CrCl = (140 - age in years) x weight in kg x 1.00

- 72 x serum creatinine in mg/dL

- Age ≥18 years of age

- Patients must have recovered from adverse events due to prior treatment to ≤
grade 1, except for alopecia and sensory neuropathy ≤ grade 2.

- Patients must be able to understand and the willingness to sign a written
informed consent document.

- Exclusion Criteria:

- Subjects with poorly differentiated or small cell carcinoma histology

- Subjects with disease that is amenable to surgical resection.

- Subjects with history of or active symptoms of carcinoid syndrome

- Hepatic intra-arterial embolization or peptide receptor radionuclide therapy
(PRRT) within 4-8 weeks; cryoablation, radiofrequency ablation or trans-arterial
chemoembolization of hepatic metastases within ≤ 4 weeks of study enrollment

- Subjects with symptomatic untreated CNS metastases are excluded.

- Subjects are eligible if CNS metastases are asymptomatic or adequately treated
and subjects are neurologically returned to baseline (except for residual signs
or symptoms related to the CNS treatment) for at least 2 weeks prior to first
treatment.

- In addition, subjects must be either off corticosteroids, or on a stable or
decreasing dose of <10 mg daily prednisone (or equivalent) for at least 2 weeks
prior to first treatment.

- Subjects with carcinomatous meningitis

- Subjects must have recovered from the effects of major surgery or significant
traumatic injury at least 14 days before first treatment.

- Pregnant or breast-feeding women

- Women of child-bearing potential, who are biologically able to conceive, and not
employing two forms of highly effective contraception. Highly effective
contraception must be used throughout the trial and up to 8 weeks after the last
dose of study drug (e.g. male condom with spermicidal; diaphragm with spermicide;
intra-uterine device). Women of child-bearing potential, defined as sexually
mature women who have not undergone a hysterectomy or who have not been naturally
postmenopausal for at least 12 consecutive months (i.e., who has had menses any
time in the preceding 12 consecutive months), must have a negative serum
pregnancy test ≤ 14 days prior to starting study drug.

- Subjects with an active, known or suspected autoimmune disease. Subjects with
type I diabetes mellitus, hypothyroidism only requiring hormone replacement, skin
disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic
treatment, or conditions not expected to recur in the absence of an external
trigger are permitted to enroll.

- Other active malignancy requiring concurrent intervention.

- Subjects with a condition requiring systemic treatment with either
corticosteroids (> 10 mg daily prednisone equivalent) or other immunosuppressive
medications within 14 days of first treatment. Inhaled or topical steroids, and
adrenal replacement steroid 10 mg daily prednisone equivalent, are permitted in
the absence of active autoimmune disease.

- Subjects with interstitial lung disease that is symptomatic or may interfere with
the detection or management of suspected drug-related pulmonary toxicity.

- Known history of testing positive for human immunodeficiency virus (HIV) or known
acquired immunodeficiency syndrome (AIDS).

- Known medical condition that, in the investigator's opinion, would increase the
risk associated with study participation or study drug administration or
interferes with the interpretation of safety results.

- Prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CTLA-4 antibody,
or any other antibody or drug specifically targeting T-cell co-stimulation or
checkpoint pathways

- Any positive test for hepatitis B virus or hepatitis C virus indicating acute or
chronic infection

- History of allergy or hypersensitivity to study drug components