Ipilimumab and Lenalidomide in Advanced Cancer

Study Groups:

Dose escalation:

If you are found to be eligible to take part in this study, you will be assigned to a dose
level of the study drugs based on when you join the study.

Up to 5 dose levels of ipilimumab with lenalidomide will be tested. Up to 6 participants will
be enrolled at each dose level. The first group of participants will receive the lowest dose
level. Each new group will receive a higher dose than the group before it, if no intolerable
side effects were seen. This will continue until the highest tolerable dose of ipilimumab
with lenalidomide is found.

Dose expansion:

Once the highest tolerable dose of ipilimumab with lenalidomide is found, up to 14 more
participants may be enrolled. This will be to further study the safety of the combination of
drugs at that dose and the level of effectiveness of the study drugs in a certain tumor
group. This group will be called the dose expansion group.

Study Drug Administration:

Each study cycle is 28 days.

You will take lenalidomide by mouth on Days 1-21 of each cycle. You will swallow the capsules
whole with water once a day. Do not break, chew, or open your capsules. The doctor will
discuss this with you.

You will receive ipilimumab by vein over 90 minutes on Day 1 of each cycle. You will be
monitored for side effects for 1-2 hours after the infusion.

Study Visits:

Every study visit:

° You will be asked if you have had any side effects.

Cycle 1:

- On Day 1: blood (about 4 teaspoons) will be drawn for routine tests.

- Between Days 2 and 7: If you are able to become pregnant, you will have a blood (about 1
teaspoon) or urine pregnancy test.

- Between Days 8 and 14: Blood (about 4 teaspoons) will be drawn for routine tests. If you
are able to become pregnant, you will have a blood (about 1 teaspoon) or urine pregnancy
test.

- Between Days 15 and 21: Blood (about 4 teaspoons) will be drawn for routine tests. If
you are able to become pregnant, you will have a blood (about 1 teaspoon) or urine
pregnancy test.

- Between Days 22 and 28: Blood (about 4 teaspoons) will be drawn for routine tests. Your
medical history will be recorded.

Cycle 2:

- On Day 1: Blood (about 4 teaspoons) will be drawn for routine tests.

- On Day 8 (+/- 3 days): Blood (about 4 teaspoons) will be drawn for routine tests.

- On Day 15 (+/- 3 days): Blood (about 4 teaspoons) will be drawn for routine tests.

- On Day 22 (+/- 3 days): Blood (about 4 teaspoons) will be drawn for routine tests.

Every other cycle (every 8 weeks):

° You will have an x-ray, CT scan, and/or PET/CT scan to check the status of the disease. °
Blood (about 1 tablespoon) will be drawn for tumor marker testing.

Before starting Cycle 3 and all following cycles:

- Your medical history will be recorded.

- You will have a physical exam, including measurement of your weight and vital signs.

- You will be asked about any health problems you may have and any other drugs or herbal
supplements you may be taking.

- Your performance status will be recorded.

- Blood (about 4 teaspoons) will be drawn for routine tests. Blood may be drawn more often
if your doctor thinks it is needed.

- If you are able to become pregnant, you will have a blood (about 1 teaspoon) or urine
pregnancy test.

At the End of the study:

- Directly at the end of the study: If you are able to become pregnant, you will have a
blood (about 1 teaspoon) or urine pregnancy test.

- 28 days after therapy with lenalidomide stopped: If you are able to become pregnant, you
will have a blood (about 1 teaspoon) or urine pregnancy test.

Length of Dosing:

You may receive up to 4 doses of ipilimumab. You may continue receiving lenalidomide for as
long as the doctor thinks it is in your best interest. You will no longer be able to take the
study drugs if the disease gets worse, if intolerable side effects occur, or if you are
unable to follow study directions.

You will be off study after your follow-up visit.

Follow-up:

You will have a follow-up-visit within 30 days after your last dose of study drugs. You will
be asked about any health problems you may have and if you have had any side effects. If your
study doctor thinks it is needed, you may have follow-up for a longer period of time. If you
are able to become pregnant, you will have a blood (about 1 teaspoon) or urine pregnancy
test.

This is an investigational study. Ipilimumab is FDA approved and commercially available to
treat metastatic melanoma. Lenalidomide is FDA approved and commercially available to treat
multiple myeloma and myelodysplastic syndrome. Giving the combination of ipilimumab and
lenalidomide to patients with advanced cancer is investigational.

Up to 101 patients will be enrolled in this study. All will be enrolled at MD Anderson.

Inclusion Criteria:

1. Patients with advanced or metastatic cancers with no available standard therapy are
eligible to enter the Phase 1 portion of this study.

2. Patients must be >/= 18 years.

3. Patients must be >/= 3 weeks beyond treatment with a cytotoxic chemotherapy regimen,
or therapeutic radiation, or major surgery. A confirmation (written or verbal) that
there is no risk of surgical complications from a patient's surgeon has to be obtained
prior to starting therapy in patients with a history of major surgery within past 6
weeks. Patients may have received palliative localized radiation immediately before or
during treatment provided that radiation is not delivered to the only site of disease
being treated under this protocol. For biologic/targeted agents patients must be >/= 5
half-lives or >/= 3 weeks form the last dose (whichever comes first).

4. ECOG performance status
5. Patients must have adequate organ and marrow function defined as: absolute neutrophil
count >/= 1,000/mL platelets >/=50,000/mL; CrCl >/=60mL/min by Cockcroft -Gault
calculation; total bilirubin indirect hyperbilirubinemia such as Gilbert syndrome); ALT(SGPT) willingness to participate in the RevAssist® program. Females: two effective
contraceptive methods should be used during therapy, during therapy interruptions, and
for at least 4 weeks after completing therapy. Males: must always use a latex condom
during any sexual contact with females of childbearing potential, even if they have
undergone a successful vasectomy.

6. Patients must be able to understand and be willing to sign a written informed consent
document.

Exclusion Criteria:

1. Uncontrolled intercurrent illness, including, but not limited to, uncontrolled
infection, uncontrolled asthma, need for hemodialysis, need for ventilatory support.

2. Pregnant or lactating women.

3. History of hypersensitivity to ipilimumab.

4. History of hypersensitivity to lenalidomide.

5. Patients unwilling or unable to sign informed consent document.

6. Patients on hemodialysis.

7. History of organ transplantation.

8. History of autoimmune disease, including inflammatory bowel disease.

9. History of severe motor or sensory neuropathy, or any other autoimmune disorder which
is deemed to be significant.

10. Patients with a prior history of Grade 4 rash associated with thalidomide treatment.

11. History of Angioedema.