Clinical Trial Details
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NCT03174197 : Atezolizumab (aPDL1) + Temozolomide and Radiation for Newly Diagnosed Glioblastoma (GBM)
PhasePhase 1/Phase 2
AgesMin: 18 Years Max: N/A
Inclusion Criteria:

1. Signed Informed Consent Form (ICF)

2. Ability and willingness to comply with the requirements of the study protocol

3. Age >/= 18 years.

4. Have histologically confirmed World Health Organization Grade IV glioma (glioblastoma
or gliosarcoma).

5. Patients must have undergone surgery and must not have had any further treatment
following surgery.

6. Have a performance status of >/= 60 on the Karnofsky Performance Status (KPS).

7. A baseline brain MRI obtained no more than 14 days prior to study enrollment on a
stable or tapering dose of steroids no greater than 4 mg a day of dexamethasone for at
least 5 days.

8. Patients must start treatment within 6 weeks of definitive resection.

9. Demonstrate adequate organ function as defined in the following: Absolute neutrophil
count (ANC) >/= 1,500 /mcL; Platelets >/= 100,000 /mcL; Hemoglobin >/= 9 g/dL or >/=
5.6 mmol/L; Serum creatinine OR Measured or calculated creatinine clearance (GFR can
also be used in place of creatinine or CrCl) >/= 60 mL/min for subject with creatinine levels > 1.5 X institutional ULN; Serum
total bilirubin bilirubin levels > 1.5 ULN; AST (SGOT) and ALT (SGPT) Normalized Ratio (INR) or Prothrombin Time (PT) Activated Partial Thromboplastin Time
10. Have provided tissue from an archival tissue sample.

11. All screening labs should be performed within 14 days (+3 working days) of treatment

12. Female subject of childbearing potential should have a negative serum pregnancy test
within 14 days (+ 3 working days) of study enrollment.

13. Female subjects of childbearing potential should be willing to use 2 methods of birth
control or be surgically sterile, or abstain from heterosexual activity for the
duration of the study. Subjects of childbearing potential are those who have not been
surgically sterilized or have not been free from menses for > 1 year.

14. Male subjects should agree to use an adequate method of contraception during the
course of the study.

Exclusion Criteria:

1. Has received prior interstitial brachytherapy, implanted chemotherapy, or therapeutics
delivered by local injection or convection enhanced delivery. Prior treatment with
Gliadel® wafers will be excluded. Prior treatment with the Optune® device will be

2. Is currently participating or has participated in any other newly diagnosed
therapeutic trial before or after chemoradiation.

3. Any serious medical condition that interferes with adherence to study procedures.

4. Patients may not receive concomitant chemotherapy, hormonal therapy, immunotherapy, or
radiotherapy while patients are on study.

5. Malignancies other than the disease under study within 5 years prior to Cycle 1, Day
1, with the exception of those with a negligible risk of metastasis or death and with
expected curative outcome (such as adequately treated carcinoma in situ of the cervix,
basal or squamous cell skin cancer, or ductal carcinoma in situ treated surgically
with curative intent) or undergoing active surveillance per standard-of-care
management (e.g., chronic lymphocytic leukemia Rai Stage 0).

6. Has known gliomatous meningitis, extracranial disease, or multifocal disease. Subject
has multifocal GBM, defined as discrete sites of disease without contiguous T2/FLAIR
abnormality that require distinct radiotherapy ports. Satellite lesions that are
associated with a contiguous area of T2/FLAIR abnormality as the main lesion(s) and
that are encompassed within the same radiotherapy port as the main lesion(s) are

7. Has evidence of interstitial lung disease or active, non-infectious pneumonitis.

8. Has an active infection requiring systemic therapy.

9. Has a history or current evidence of any condition, therapy, or laboratory abnormality
that might confound the results of the trial, interfere with the subject's
participation for the full duration of the trial, or is not in the best interest of
the subject to participate, in the opinion of the treating investigator.

10. Has known psychiatric or substance abuse disorders that would interfere with
cooperation with the requirements of the trial.

11. Is pregnant or breastfeeding, or expecting to conceive or father children within the
projected duration of the trial, starting with the screening visit.

12. Contraindication for undergoing MRIs

13. Inability to comply with study and follow-up procedures

14. History or risk of autoimmune disease, including but not limited to systemic lupus
erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis
associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjögren's
syndrome, Bell's palsy, Guillain-Barré syndrome, multiple sclerosis, autoimmune
thyroid disease, vasculitis, or glomerulonephritis. Patients with a history of
autoimmune hypothyroidism on a stable dose of thyroid replacement hormone may be
eligible. Patients with controlled Type 1 diabetes mellitus on a stable insulin
regimen may be eligible.

15. (14. continued) Patients with eczema, psoriasis, lichen simplex chronicus of vitiligo
with dermatologic manifestations only (e.g., patients with psoriatic arthritis would
be excluded) are permitted provided that they meet the following conditions: Patients
with psoriasis must have a baseline ophthalmologic exam to rule out ocular
manifestations; Rash must cover less than 10% of body surface area (BSA); Disease is
well controlled at baseline and only requiring low potency topical steroids (e.g.,
hydrocortisone 2.5%, hydrocortisone butyrate 0.1%, fluocinolone 0.01%, desonide 0.05%,
alclometasone dipropionate 0.05%); No acute exacerbations of underlying condition
within the last 12 months (not requiring psoralen plus ultraviolet A radiation [PUVA],
methotrexate, retinoids, biologic agents, oral calcineurin inhibitors; high potency or
oral steroids).

16. History of idiopathic pulmonary fibrosis, pneumonitis (including drug induced),
organizing pneumonia (i.e., bronchiolitis obliterans, cryptogenic organizing
pneumonia, etc.), or evidence of active pneumonitis on screening chest computed
tomography (CT) scan. History of radiation pneumonitis in the radiation field
(fibrosis) is permitted.

17. Any other diseases, metabolic dysfunction, physical examination finding, or clinical
laboratory finding giving reasonable suspicion of a disease or condition that
contraindicates the use of an investigational drug or that may affect the
interpretation of the results or render the patient at high risk from treatment

18. History of HIV infection or active hepatitis B (chronic or acute) or hepatitis C
infection. Patients with past or resolved hepatitis B infection (defined as having a
negative hepatitis B surface antigen [HBsAg] test and a positive anti-HBc [antibody to
hepatitis B core antigen] antibody test) are eligible. Patients will be sampled for
HBV DNA and will be referred to a virologist to monitor for HBV re-activation.
Patients positive for hepatitis C virus (HCV) antibody are eligible only if polymerase
chain reaction (PCR) is negative for HCV RNA.

19. Active tuberculosis

20. Severe infections within 4 weeks prior to Cycle 1, Day 1, including but not limited to
hospitalization for complications of infection, bacteremia, or severe pneumonia

21. Signs or symptoms of infection within 2 weeks prior to Cycle 1, Day 1

22. Received oral or IV antibiotics within 2 weeks prior to Cycle 1, Day 1. Patients
receiving prophylactic antibiotics (e.g., for prevention of a urinary tract infection
or chronic obstructive pulmonary disease) are eligible.

23. Anticipation of need for a major surgical procedure during the course of the study

24. Administration of a live, attenuated vaccine within 4 weeks before Cycle 1, Day 1 or
anticipation that such a live, attenuated vaccine will be required during the study.
Influenza vaccination should be given during influenza season only (approximately
October to March). Patients must not receive live, attenuated influenza vaccine (e.g.,
FluMist) within 4 weeks prior to Cycle 1, Day 1 or at any time during the study and
for 5 months after last dose of atezolizumab.

25. Malignancies other than the disease under study within 5 years prior to Cycle 1, Day
1, with the exception of those with a negligible risk of metastasis or death and with
expected curative outcome (such as adequately treated carcinoma in situ of the cervix,
basal or squamous cell skin cancer, localized prostate cancer treated surgically with
curative intent, or ductal carcinoma in situ treated surgically with curative intent)
or undergoing active surveillance per standard-of-care management (e.g., chronic
lymphocytic leukemia Rai Stage 0, prostate cancer with Gleason score prostate-specific antigen [PSA]
26. Prior treatment with anti-PD-1, or anti-PD-L1 therapeutic antibody or pathway
targeting agents.

27. Treatment with systemic immunostimulatory agents (including but not limited to
interferon [IFN]-a or interleukin [IL]-2) within 6 weeks or five half-lives of the
drug (whichever is shorter) prior to Cycle 1, Day 1

28. Treatment with systemic immunosuppressive medications (including but not limited to
prednisone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor
necrosis factor [anti-TNF] agents) within 2 weeks prior to Cycle 1, Day 1. Patients
who have received acute, low dose, systemic immunosuppressant medications (e.g., a
one-time dose of dexamethasone for nausea) may be enrolled. The use of inhaled
corticosteroids and mineralocorticoids (e.g., fludrocortisone) for patients with
orthostatic hypotension or adrenocortical insufficiency is allowed.

29. History of severe allergic, anaphylactic, or other hypersensitivity reactions to
chimeric or humanized antibodies or fusion proteins

30. Patients with prior allogeneic bone marrow transplantation or prior solid organ
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