13.4. Cardiac Monitoring Troponin I or T and ECGs will be used in the first month of the study to monitor for signs of immune -related cardiotoxicity as per Table 2. The following actions should be taken in the event of changes in cardiac monitoring tests: - Isolated Troponin I or T elevation: o Delay HS -110 and additional study drug treatment (nivolumab, pembrolizumab, or pembrolizumab /pemetrexed) . o Assess patient for new onset of chest pain, shortness of breath, orthopnea (shortness of breath when lying down) , or syncope . o Perform ECG and ECHO to evaluate for new evidence of heart block , reduction in LVEF , pericardial effusion, or other abnormalities. o Repeat Troponin I or T in 2-3 days . o If new symptoms have developed and/or repeat troponin remains elevated (above upper limit of normal per institution), consider discontinuation of therapy and cardiology cons ultation. In this event contact Medical Monitor to discuss the case . o If Troponin decreases with no other clinically significant findings, treatment can be restarted after discussion and approval by M edical Monitor. - ECG evidence of heart block: o Delay HS -110 and additional study drug treatment (nivolumab, pembrolizumab, or pembrolizumab /pemetrexed) . o Assess patient for new onset of chest pain, shortness of breath, orthopnea (shortness of breath when lying down), and syncope. o Perform ECHO to evaluate for reduction (> 10% reduction from baseline or below lower limit of normal per institution) in LVEF, pericardial effusion, or other abnormalities. o Repeat ECG in 2 -3 days. o If new symptoms have developed and/or repeat ECG remains abnormal consider discontinuation of therapy and cardiology consultation. In this event contact Medical Monitor to discuss the case. Heat Biologics, Inc. Viagenpumatucel -L Protocol HS110 -102 CONFIDENTIAL Amendment 6, 24 May 2019 Page 61 of 95 o Treatment must be permanently discontinued in confirmed cases of acute onset heart block . All cases must be discussed with Medical Monitor.