Atezolizumab and Pre-Surgical Brain Radiation Therapy for Glioblastoma Multiforme

Study Overview
=================
Brief Summary
-----------------
This is a single-arm pilot study that will recruit 12 patients with newly diagnosed Glioblastoma, a malignant brain tumor with a poor prognosis. Patients will be treated with fractionated stereotactic radiotherapy (FSRT) for 2 weeks, in addition to two doses of Atezolizumab (Tecentriq), an FDA approved PD- L1 inhibitor drug, 840 mg IV, at the beginning and at the end of the two-week time period, concomitantly with FSRT. After this initial two weeks treatment the patients will undergo craniotomy and maximal safe resection as per normal care for a GB. After surgery patients will follow the normal care for glioblastoma in addition to Atezolizumab 840 mg IV q2 weeks for the duration of adjuvant treatment.

Official Title
-----------------
A Pilot Study to Evaluate the Immunogenic Effects of Window-of-Opportunity Fractionated Stereotactic Radiotherapy Combined With Atezolizumab for Patients With Newly Diagnosed WHO CNS Grade 4 Glioma (Glioblastoma Multiforme)

Conditions
-----------------
Glioblastoma Multiforme

Intervention / Treatment
-----------------
* Combination Product: Atezolizumab + FSRT radiation


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Diagnosis of glioblastoma multiforme WHO Grade IV The patient is a surgical candidate, with the surgical intent for a > 80% resection of the lesion Negative pregnancy test ECOG status <= 2 Tumor volume <= 3.5 cm Adequate organ function Negative for infectious disease (human immunodeficiency virus, Hepatitis B Virus, Hepatitis C Virus, tubercolosis) Exclusion Criteria: Presence of leptomeningeal disease, gliomatosis cerebri, multifocal disease, bilateral cerebral hemisphere involvement (butterfly gliomas) Patients at increased risk of neurologic decompensation Continued use of high dose intravenous or oral corticosteroids, or > 8milligrams per day of systemic dexamethasone Uncontrolled tumor-related pain Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently) Uncontrolled or symptomatic hypercalcemia History of autoimmune disease or immune deficiency History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, or idiopathic pneumonitis, or evidence of active pneumonitis Significant cardiovascular disease History of other malignancy within 1 year prior to screening Severe infection within 4 weeks prior to initiation of study treatment History of allogeneic stem cell or organ transplant Prior treatment with CD137 agonists or immune checkpoint blockade therapies Treatment with systemic immunostimulatory agents Treatment with systemic immunosuppressive medication

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment<br> | Combination Product: Atezolizumab + FSRT radiation<br>* Atezolizumab 840mg IV every 2 weeks Fractionated Stereotactic Radiotherapy<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants who progress/relapse after surgical resection | Assess the efficacy of atezolizumab in combination with fractionated stereotactic radiation therapy in the neoadjuvant setting for resectable glioblastoma multiforme | 2 years | 
| Number of participants with treatment-related adverse events as assessed by CTCAE v5.0 | Assess the safety of atezolizumab in combination with fractionated stereotactic radiation therapy in the neoadjuvant setting for resectable glioblastoma multiforme | 30 days after the last dose of atezolizumab |