A Phase 1 Trial of CTLA-4 Inhibition, with or without Cetuximab, and in Combination with Memory-like Natural Killer (NK) Cell Immune Cell Therapy in Advanced Head & Neck Cancer

This research study is evaluating the safety and efficacy of a combination drug and biologic
therapy in patients with advanced head and neck cancer.

This research study involves the following drugs and biologics:

- CIML NK donor cells

- IL-15 superagonist

- Ipilimumab

- Cetuximab

Inclusion Criteria:

- Histologically or cytologically confirmed, recurrent or metastatic squamous cell
carcinoma of the head neck (including oral cavity, oropharynx, larynx, hypopharynx,
paranasal sinuses) or salivary gland carcinoma (including adenoid cystic carcinoma and
non-adenoid cystic carcinoma histologies)

- Any HPV status or smoking history is permitted. Oropharyngeal cancer patients are
required to undergo HPV testing with p16 immunohistochemistry and/or confirmatory HPV
PCR or ISH testing

- Available haploidentical donor that is willing and eligible for non-mobilized
collection

- Prior exposure to a platinum-containing regimen (either in the definitive or advanced,
recurrent/metastatic setting) and exposure to a PD-1/L1 inhibitor is required for
SCCHN patients only

- Age 18 years or older

- ECOG performance status ≤ 2 (see Appendix A).

- No systemic corticosteroid therapy (≤ 10 mg of prednisone or equivalent dose of
systemic steroids for non-autoimmune indications for at least 4 weeks prior to NK cell
infusion).

- Ability to understand and the willingness to sign a written informed consent document.

- Negative pregnancy test for women of childbearing potential only. Women of
childbearing potential (WOCBP) must have a negative serum or urine pregnancy test
(minimum sensitivity 25 IU/L or equivalent units of HCG) within 72 hours before the
start of ipilimumab.

- The effects of CIML NK cells and N-803 on the developing human fetus are unknown.

For this reason, WOCBP and men must agree to use adequate contraception (hormonal or
barrier method of birth control; abstinence) prior to study entry and for the duration of
study participation, and for up to 26 weeks after the last dose of all investigational
products (up to 16 weeks after the last N-803 dose), in such a manner that the risk of
pregnancy is minimized. Should a woman become pregnant or suspect she is pregnant while she
or her partner is participating in this study, she should inform her treating physician
immediately.

- Willing to provide blood and tissue from diagnostic biopsy and at the time of surgery

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

- leukocytes ≥ 2,500/mcL

- absolute neutrophil count ≥ 1,000/mcL

- platelets ≥ 90,000/mcL

- total bilirubin ≤ 1.5x institutional upper limit of normal (ULN)

- AST(SGOT)/ALT(SGPT) ≤ 3x institutional upper limit of normal

- creatinine within normal institutional limits OR

- creatinine clearance ≥ 60 mL/min/1.73 m2 for participants with creatinine levels
above institutional normal.

- Oxygen saturation: ≥ 90% on room air

- Left ventricular ejection fraction (cardiac function) > 40%

Exclusion Criteria:

- Patients with nasopharyngeal carcinoma are not eligible

- Participants who have had anti-tumor chemotherapy or other investigational agents
within 2 weeks prior to cell infusion (6 weeks for nitrosoureas or mitomycin C), or
immunotherapy within 3 weeks prior, or those who have not recovered from adverse
events due to agents administered more than 3 weeks prior.

- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to N-803 or other agents used in study.

- Solid organ transplant (allograft) recipients.

- Participants who are receiving any other investigational agents.

- Participants with known brain metastases should be excluded from this clinical trial
because of their poor prognosis and because they often develop progressive neurologic
dysfunction that would confound the evaluation of neurologic and other adverse events.

- Autoimmune disease: patients with a history of inflammatory bowel disease, including
ulcerative colitis and Crohn disease, are excluded from this study, as are patients
with a history of symptomatic disease (e.g., rheumatoid arthritis, systemic
progressive sclerosis [scleroderma], systemic lupus erythematosus, autoimmune
vasculitis [Wegener's granulomatosis]) and motor neuropathy considered of autoimmune
origin (e.g. Guillain- Barre syndrome and myasthenia gravis). Patients with Hashimoto
thyroiditis are eligible.

- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, or psychiatric illness/social situations that would limit compliance with
study requirements.

- Pregnant women are excluded from this study because of the unknown teratogenic risk of
CIML NK cells and N-803 and with the potential for teratogenic or abortifacient
effects by fludarabine/cyclophosphamide chemotherapy regimen. Because there is an
unknown but potential risk for adverse events in nursing infants secondary to
treatment of the mother with CIML NK cells and N-803, breastfeeding should be
discontinued if the mother is treated on this study.

- HIV-positive participants are ineligible because of the potential for pharmacokinetic
interactions with anti-retroviral agents used in this study. In addition, these
participants are at increased risk of lethal infections when treated with
marrow-suppressive therapy.

- Individuals with active uncontrolled hepatitis B or C are ineligible as they are at
high-risk of lethal treatment-related hepatotoxicity in the setting of marrow
suppression.

- Known non-infectious pneumonitis or any history of interstitial lung disease.

- Receipt of a live vaccine within 30 days of start of study treatment.