Phase II Study Incorporating Pegylated Interferon In the Treatment For Children With High-Risk Melanoma

This study is for children with malignant melanoma and high risk features (at high risk of
melanoma returning or spreading to other parts of the body) or who have recurrent disease.
The study has two treatment groups based on the stage of the disease. Patients with stage
IIC, IIIA or IIIB melanoma whose tumors have been removed by surgery will be treated in
study group A. These patients will receive 4 weeks of high dose interferon alfa-2b followed
by 48 weeks of peginterferon. Patients with stage IIIC or IV melanoma, stage III melanoma
that could not be removed by surgery and those with recurrent disease will be treated in
study group B. These patients will receive peginterferon alfa-2b and temozolomide.

Stratum A: Resected Stages IIC, IIIA, and IIIB patients

Induction therapy (weeks 1-4): Subjects will receive recombinant interferon alfa-2b 20
million units/m2 per day intravenously over 20-30 minutes on 5 consecutive days per week for
4 weeks. Subjects will receive peginterferon alfa-2b 1 mcg/kg/week subcutaneously for a
total of 48 weeks.

Stratum B: Resected Stage IIIC, unresectable Stage III, Stage IV, and recurrent patients

Stratum B is divided into 2 groups based on the presence (Stratum B1) or absence (Stratum
B2) of measurable disease. Subjects will receive 8 weekly doses of peginterferon alfa-2b 0.5
mcg/kg/dose subcutaneously in combination with temozolomide 75mg/m2/dose by mouth daily for
6 weeks followed by 2 week break. The duration of each treatment course will be 8 weeks.
Strata B2 (no measurable disease) will proceed with 7 courses as outlined.

Surgery interventions -Associated with both Strata A and B Surgery description: All subjects
with initial presentation of melanoma (T1-4) will be treated with primary wide local
excision with a minimum of 1cm margin (if anatomically feasible) surrounding the primary
lesion or biopsy scar. For lesions with Breslow's thickness of > 1mm or or Clark's level IV/V, a 2 cm margin is preferred when anatomically feasible. Subjects with
sentinel lymph node(s) positive for disease, will undergo complete lymph node dissection of
the involved nodal basin.

Additional objectives include:

- To assess the safety of temozolomide administered in combination with peginterferon
α-2b to pediatric patients with resected AJCC Stage IIIC, unresectable Stage III,
metastatic, or recurrent cutaneous melanoma (Stratum B).

- To study the feasibility and safety of administering peginterferon α-2b weekly for 48
weeks following an initial induction phase with intravenous high dose interferon α-2b
for 4 weeks to pediatric patients with resected thick melanomas (> 4mm) with
ulcerations (AJCC Stage IIC) and resected melanomas with regional lymph node metastases
(AJCC Stage IIIA and IIIB) (Stratum A).

Inclusion Criteria:

- AJCC stage IIC, III, IV or recurrent cutaneous melanoma

- Adequate bone marrow function

- Age less than or equal to 21 years of age at diagnosis

- Adequate liver and kidney function

Exclusion Criteria:

- Prior Therapy with dacarbazine or temozolomide

- Patients who have uncontrolled infection

- Patients with autoimmune hepatitis

- Patients who have a history of depression or other psychiatric diseases requiring
hospitalization

- Patients taking systemic corticosteroids including oral steroids (i.e. prednisone,
dexamethasone) or topical steroid creams/ointments. Steroid containing inhalers,
steroid replacement for adrenal insufficiency and steroid premedication for
prevention of transfusion or imaging contrast-agent related allergic reaction will be
permitted.

- Patients with hypersensitivity reaction to non-pegylated interferon α-2b are not
eligible for study

- Patients with diabetes mellitus not adequately controlled with medication

- Patients with hypo- or hyperthyroidism not adequately controlled with medication.

- Patients with a history of myocardial infarction, severe or unstable angina, or
severe peripheral vascular disease.