Overview

Background

Glioblastoma (GBM) is a type of malignant glioma. These cancers are nearly always fatal. People who develop these cancers get aggressive treatments. But the tumors almost always recur. Researchers want to study people with newly diagnosed disease to learn more.

Objective

To study people with newly diagnosed GBM or gliosarcoma to look at the changes in immune cells in the blood of those who take ipilimumab and nivolumab, along with temozolomide.

Eligibility

Adults ages 18 and older with newly diagnosed GBM or gliosarcoma, who have had surgical removal of their tumor and have completed standard initial chemotherapy and radiation therapy.

Design

Participants will be screened with the following:

Medical record review

Medical history

Physical exam

Tests to assess their nervous system and their ability to do typical activities

Blood tests

Tumor assessment. For this, they will have magnetic resonance imaging (MRI). They may get a contrast dye through an intravenous (IV) catheter. The MRI scanner makes noise. They will get earplugs.

Electrocardiogram. It measures heart rate and rhythm. They will lie still. Sticky pads will be placed on their chest, arms, and legs.

Screening tests will be repeated during the study.

Treatment will be given in cycles. Each cycle lasts 4 weeks. Participants will get nivolumab and ipilimumab via IV. They will take temozolomide by mouth. They will keep a pill diary.

Participants will fill out surveys about their symptoms.

Participants will have follow-up visits about 60 days and 100 days after treatment ends. Then they will be contacted every 6 months for the rest of their life.

Eligibility

• INCLUSION CRITERIA:
  • Participants must have newly diagnosed histologically confirmed primary glioblastoma or gliosarcoma
  • Participants must have undergone an extensive resection of unifocal, confined to the supratentorial compartment, tumor.
  • Participant must have completed chemoradiation (external beam radiation with concurrent temozolomide) a maximum of 5 weeks prior to initiation of study therapy. Potential participants who have a limited short term, reversable, unrelated to their underlying disease, concurrent illness, the initiation of treatment may be delayed up to 14 days, if the participant meet all other I/E criteria at that time.
  • Age greater than or equal to 18 years.
  • Karnofsky greater than or equal to 70%
  • Participants must have adequate organ and marrow function as defined below:
    • Absolute neutrophil count greater than or equal to 1,500/mcL
    • Platelet Count >100,000/mcL
    • Hemoglobin > 9.0 g/dL (may be transfused to achieve this level)
    • BUN less than or equal to 30 mg/dL
    • Serum creatinine less than or equal to 1.7 mg/dL or creatinine clearance as measured by 24 hour urine collection as > 60 ml/min.
    • Total bilirubin (except participants with Gilbert s Syndrome, who are eligible for the study but exempt from the total bilirubin eligibility criterion) less than or equal to 2.0 mg/dL
    • ALT and AST less than or equal to 2.5x institutional upper limit of normal.
  • The effects of study treatment on the developing human fetus are unknown. For this

    reason, participants of reproductive potential must agree to abstinence or use adequate contraception which includes a combination of TWO of the following:

    • Barrier method of contraception: condoms (male or female) with or without a spermicidal agent, diaphragm, or cervical cap with spermicide
    • IUD
    • Hormone-based contraceptive
    • Tubal ligation

        Note: Consider use in females only or both male and female participants starting from the
        enrollment and for the duration of study treatment and up to 6 months (women) after the
        last dose of study drug and 6 months (men) after the last dose of temozolomide. 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.
        -The participant must be able to understand and be willing to sign a written informed
        consent document.
        EXCLUSION CRITERIA:
          -  Definitive clinical or radiologic evidence of progressive disease.
          -  Prior placement of Gliadel wafer or local brachytherapy. Note: Tumor Treating Fields
             are allowed.
          -  Participants who are receiving any other investigational agents.
          -  Participants who have a history of receiving immune therapy, such as a vaccine
             therapy, dendritic cell vaccine or intracavitary or convectional enhanced delivery of
             therapy.
          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to nivolumab, ipilimumab or temozolomide.
          -  History of allergic reactions attributed to gadolinium contrast.
          -  History of severe hypersensitivity reaction to any monoclonal antibody.
          -  Prior or concurrent malignancy unless its natural history or treatment does not have
             the potential to interfere with the safety or efficacy assessment of the
             investigational regimen.
          -  Participants with active autoimmune disease or history of autoimmune disease that
             might recur, which may affect vital organ function or require immune suppressive
             treatment including systemic corticosteroids. These include but are not limited to
             participants with a history of immune related neurologic disease, multiple sclerosis,
             autoimmune (demyelinating) neuropathy, Guillain-Barre syndrome or CIDP, myasthenia
             gravis; systemic autoimmune disease such as SLE, connective tissue diseases,
             scleroderma, inflammatory bowel disease
        (IBD), Crohn s, ulcerative colitis, and hepatitis; and participants with a history of toxic
        epidermal necrolysis (TEN), Stevens-Johnson syndrome, or phospholipid syndrome. Such
        diseases should be excluded because of the risk of recurrence or exacerbation of disease.
        Note: Participants with vitiligo, endocrine deficiencies including thyroiditis managed with
        replacement hormones including physiologic corticosteroids are eligible. Participants with
        rheumatoid arthritis and other arthropathies, Sjogren s syndrome, psoriasis controlled with
        topical medication, and participants with positive serology, such as antinuclear antibodies
        (ANA) and anti-thyroid antibodies should be evaluated for the presence of target organ
        involvement and potential need for systemic treatment but should otherwise be eligible.
          -  The participant must not be currently on a corticosteroid dose greater than
             physiologic replacement dosing defined as 30 mg of cortisone per day or its
             equivalent. Participants must have stopped corticosteroids above this threshold at
             least 7 days prior to initiation of study treatment.
          -  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 (within timeframes identified in
             the bullets below) that
        would limit compliance with study requirements.
        -Pregnant women are excluded from this study because study treatment potential for
        teratogenic or abortifacient effects is unknown. Because there is an unknown but potential
        risk for adverse events in nursing infants secondary to study treatment of the mother,
        breastfeeding should be discontinued.
        -Known active, chronic, or history of hepatitis infection.