Vanderbilt-Ingram Cancer Center

This study has two parts or 'Phases.' The study treatment is PX-866 plus vemurafenib. Phase 1 is the Dose Escalation part, where increasingly higher doses of PX-866 will be given to groups of patients, along with a specific dose of vemurafenib. In Phase 1, the sponsor and study doctors want to learn: -- The highest PX-866 dose that can safely be given with vemurafenib, with the fewest side effects. (This dose of PX-866 is called the maximum tolerated dose, or MTD.) -- What are the side effects of PX-866 when given with vemurafenib- Phase 2 is the Dose Expansion part, where participants will be randomized by the sponsor to receive either combination treatment with vemurafenib + PX-866 together, or treatment with vemurafenib alone. In Phase 2, the sponsor and study doctors want to learn: -- How effective is PX-866 (at the MTD) when given with vemurafenib in controlling advanced cancer-

Criteria
 Inclusion Criteria:

 • ≥ 18 years at time of consent

 • If a sexually active male or a sexually active female of child-bearing potential, agrees to use a highly effective form of contraception (including birth control pills, barrier device, or intrauterine device)from the time of consent 90 days following the last dose of study drug

 • If female of child-bearing potential, negative pregnancy test

 • For Phase 1: must have histologically or cytologically-confirmed advanced cancer that is BRAF mutation-positive (V600E or V600K) for which there is no remaining standard therapy with curative potential. Patients must have disease sites amenable to biopsy. For Phase 2: must have histologically or cytologically-confirmed BRAF mutation-positive (V600E or V600K) advanced (defined as unresectable Stage IIIC or IV) melanoma that has not been treated with a selective BRAF inhibitor

 • For Phase 1: must have measurable or non-measurable disease. For Phase 2: must have measurable disease per RECIST 1.1

 • For Phase 1: no restriction on number of prior therapy regimens. For Phase 2: the following restrictions on prior therapy apply: 1) must not have been treated with a selective BRAF inhibitor and must not have had more than 2 prior treatment regimens for advanced metastatic disease; 2) must have completed prior cytotoxic chemotherapy a minimum of 4 weeks prior to starting PX-866 and/or vemurafenib (except for BCNU and/or mitomycin C, which must have been completed a minimum of 6 weeks prior to starting therapy). Prior biologic therapy and localized radiation therapy must have been completed a minimum of 2 weeks prior to starting therapy.

 • All toxicities related to prior cancer therapies other than alopecia must have resolved to Grade 1 or less

 • Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1

 • In the opinion of the clinical investigator, life expectancy > 3 months

 • Adequate hematologic function

 • Adequate hepatic function

 • Serum creatinine < 2.0 mg/dL

 • Adequate cardiac function

 • Corrected QTc must be <480 milliseconds

 Exclusion Criteria:

 • May not be receiving any other investigational agents

 • Active central nervous system (CNS) metastases are excluded. Patients with a history of CNS metastasis, who have been treated prior to enrollment, must be stable for eight weeks after completion of treatment. These patients must have undergone appropriate imaging studies and currently be on a stable, lowest possible dose of steroids

 • History of allergic reactions attributed to compounds of similar chemical or biologic composition to PX-866 or vemurafenib

 • 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

 • Uncorrectable electrolyte abnormalities or long QT syndrome

 • Poorly controlled diabetes mellitus

 • Pregnant, breastfeeding, or planning to become pregnant

 • Known to be human immunodeficiency virus (HIV)-positive

 • Inability to swallow pills

 • Previous treatment with a phosphatidylinositol-3-kinase (PI-3K) inhibitor

 • Any other significant medical or psychiatric condition that in the opinion of the investigator renders the patient inadequate for participation