Inclusion Criteria:
- - Newly-diagnosed adults with WHO (World Health Organization) Grade IV Glioblastoma or
gliosarcoma based on histopathological or molecular criteria who had carmustine
wafers placed at resection.
- - No prior treatment for GBM other than surgical resection and carmustine wafer
placement (Patients who had a biopsy prior to resection are allowed)
- Post-operative MRI or CT scan within 72 hours (preferably 24 hours) of surgical
resection.
- - Substantial recovery from surgical resection.
- - On a stable or decreasing dose of steroids.
- - Karnofsky Performance Status of ≥ 60.
- - Clinically appropriate for concomitant temozolomide plus radiation therapy (RT)
based on institutional guidelines.
- - Ensure that pregnant or lactating females are not enrolled and that contraceptive
requirements are in accordance with applicable and recent requirements.
- - Men must agree to take appropriate precautions to avoid fathering children (with at
least 99% certainty) from screening through 180 days after the last dose of
retifanlimab.
- - Must have normal organ and marrow function on routine laboratory tests.
- - Ability to understand and the willingness to sign a written informed consent
document.
- - Subjects must be willing and able to comply with scheduled visits, treatment
schedule, study procedures, and other requirements of the study.
Exclusion Criteria:
- - Recurrent glioblastoma (GBM) or progression of lower grade tumor.
- - Central nervous system (CNS) hemorrhage of Grade > 1 on baseline MRI scan, unless
subsequently documented to have resolved.
- - Any known metastatic extracranial or leptomeningeal disease.
- - Intent to use other anti-neoplastic medications/treatments including the Optune®
device.
- - Any serious or uncontrolled medical disorder that, in the opinion of the
investigator, may increase the risk associated with study participation or study
drug administration, impair the ability of the subject to receive protocol therapy,
or interfere with the interpretation of study results.
- - Prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, anti-CTLA-4
antibody or any other antibody or drug specifically targeting T-cell co-stimulation
or immune checkpoint pathways.
- - Active, known or suspected autoimmune disease, with the following exceptions:
Subjects with type I diabetes mellitus, hypothyroidism only requiring hormone
replacement, skin disorders (such as vitiligo, psoriasis or alopecia) not requiring
systemic treatment (subjects with a history of flares requiring systemic treatment
are excluded), or other autoimmune conditions not expected to recur in the absence
of an external trigger are permitted to enroll.
- - Subjects with history of life-threatening toxicity, including hypersensitivity
reaction, related to prior immunoglobulin treatment for another condition (except
those considered unlikely to re-occur, with written approval of study PI) or any
other study drug component.
- - History or evidence upon physical/neurological examination of other central nervous
system condition (e.g., seizures, abscess) unrelated to cancer, unless adequately
controlled by medication or considered not potentially interfering with protocol
treatment.
- - Surgical procedure < 7 days prior to study treatment (No restriction for insertion
of a central venous access device)
- Unable to swallow oral medication or any gastrointestinal disease or surgical
procedure that may seriously impact the absorption of temozolomide.
- - Prior malignancy active within the previous 3 years except for locally curable
cancers that have been apparently cured, such as basal or squamous cell skin cancer,
totally excised melanoma of stage IIA or lower, low or intermediate-grade localized
prostate cancer (Gleason score ≤ 7), and curatively-treated carcinoma in situ of the
cervix, breast, or bladder.
- - Known history of any positive test for hepatitis B virus or hepatitis C virus
indicating acute or chronic infection, and/or detectable virus.
- - Known history of positive test for human immunodeficiency virus (HIV) or known
acquired immunodeficiency syndrome (AIDS).
- - Evidence of interstitial lung disease, history of interstitial lung disease, or
active, noninfectious pneumonitis.
- - Palliative radiation therapy administered within 1 week of first dose of study
treatment or radiation therapy in the thoracic region that is > 30 Gy within 6
months of the first dose of study treatment.
Note: Participants must have recovered
from all radiation-related toxicities (to Grade >1 or baseline), not require
corticosteroids for this purpose, and not have had radiation pneumonitis.
- - Toxicity of prior therapy that has not recovered to ≤ Grade 1 or baseline (with the
exception of any grade of alopecia and anemia not requiring transfusion support).
- - Participants with specified abnormal laboratory values at screening.
- - Active autoimmune disease requiring systemic immunosuppression in excess of
physiologic maintenance doses of corticosteroids (> 10 mg/day of prednisone or
equivalent).
- - Physiologic corticosteroid replacement therapy at doses ≤ 10 mg/day of
prednisone or equivalent for adrenal or pituitary insufficiency and in the
absence of active autoimmune disease is permitted.
- - Participants with asthma that requires intermittent use of bronchodilators,
inhaled steroids, or local steroid injections may participate.
- - Participants using topical, ocular, intra-articular, or intranasal steroids
(with minimal systemic absorption) may participate.
- - Brief courses of corticosteroids for prophylaxis (e.g., contrast dye allergy)
or study treatment-related standard premedication is permitted.
- - Has an active infection requiring systemic antibiotics or antifungal treatment.
- - History of organ transplant, including allogeneic stem cell transplantation.
- - Known allergy or hypersensitivity to any component of retifanlimab or formulation
components.
- - Has received a live vaccine within 28 days of the planned start of study drug (Note:
Examples of live vaccines include but are not limited to measles, mumps, rubella,
chicken pox/zoster, yellow fever, rabies, Bacillus of Calmette and Guerin (BCG), and
typhoid vaccine.
Inactivated seasonal influenza vaccines and COVID-19 vaccine(s) are
permitted and do not require a 4-week waiting period before starting study
treatment; however, intranasal influenza vaccines are live attenuated vaccines and
are not allowed.)
- - Patients who are taking Probiotic dietary supplements.
- - Patients with uncontrolled intercurrent illness.
- Patients with psychiatric illness/social situations (e.g. prisoners/involuntarily
incarcerated individuals) that would limit compliance with study requirements
