Anti-Lag-3 (Relatlimab) and Anti-PD-1 Blockade (Nivolumab) Versus Standard of Care (Lomustine) for the Treatment of Patients With Recurrent Glioblastoma
Anti-Lag-3 (Relatlimab) and Anti-PD-1 Blockade (Nivolumab) Versus Standard of Care (Lomustine) for the Treatment of Patients With Recurrent Glioblastoma
This phase II trial compares the safety, side effects and effectiveness of anti-lag-3 (relatlimab) and anti-PD-1 blockade (nivolumab) to standard of care lomustine for the treatment of patients with glioblastoma that has come back after a period of improvement (recurrent). Relatlimab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. A monoclonal antibody is a type of protein that can bind to certain targets in the body, such as molecules that cause the body to make an immune response (antigens). Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the tumor, and may interfere with the ability of tumor cells to grow and spread. Lomustine is a chemotherapy drug and in a class of medications called alkylating agents. It damages the cell's deoxyribonucleic acid and may kill tumor cells. Giving relatlimab and nivolumab may be safe, tolerable, and/or effective compared to standard of care lomustine in treating patients with recurrent glioblastoma.
Neuro-Oncology
Phase II
Adults
Chemotherapy - cytotoxic,
Mol. targeted/Immunotherapy/Biologics
Lomustine,
Nivolumab,
Relatlimab (BMS-986016)
Mohler, Alexander
National
Vanderbilt University
10-24-2025
Eligibility
18 Years and older
ALL
false
Inclusion Criteria:
Histologically-proven glioblastoma (World Health Organization \[WHO\] 2021 criteria)
Progressive or recurrent disease per Response Assessment in Neuro-Oncology (RANO) criteria
No IDH mutation (IDH1 R132H negative by immunohistochemistry \[IHC\] or sequencing)
Patients must be in first recurrence of glioblastoma following radiation therapy and temozolomide
No prior therapies except radiation, surgery, temozolomide, Tumor Treating Fields (TTFields), and/or Gliadel wafers (placed during the first surgery at diagnosis of glioblastoma multiforme \[GBM\]). Prior radiation therapy, TTFields, or placement of Gliadel wafers must be completed at least 2 weeks prior to registration. Prior temozolomide must be completed at least 3 weeks prior to registration
No prior use of nivolumab or other anti-PD1 agents
Patients must be neurologically stable off corticosteroids for at least 5 days prior to registration
Age: 18 years
Karnofsky Performance Status: 60% (i.e. patient must be able to care for themselves with occasional help from others)
Absolute lymphocyte count (ALC): 1000/mm\^3
Absolute neutrophil count (ANC): 1500/mm\^3
Platelet count: 100,000/mm\^3
Hemoglobin: 9.0 g/dL
Activated partial thromboplastin time (APTT) or partial thromboplastin time (PTT): 1.5 x upper limit of normal (ULN)
Total bilirubin: 2.0 x ULN (Except for patients with Gilbert's syndrome, who must have direct bilirubin 2.0 x ULN)
Aspartate aminotransferase (AST) / alanine aminotransferase (ALT): 3.0 x ULN
Calculated (calc.) creatinine clearance (CrCl): 50 mL/min * Calculated by Cockcroft-Gault equation
Not pregnant and not nursing, because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown and an agent that has known genotoxic, mutagenic and teratogenic effects. Therefore, for women of childbearing potential only, a negative pregnancy test done within 14 days prior to registration is required
Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
No active brain metastases or leptomeningeal disease
HIV: HIV-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months prior to registration are eligible for this trial
Hepatitis B: For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
Hepatitis C: Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
No known medical condition causing an inability to swallow oral formulations of agents
No current symptomatic pulmonary disease
No autoimmune disorders that require systemic treatment (except hyperthyroidism or diabetes mellitus)
Histologically-proven glioblastoma (World Health Organization \[WHO\] 2021 criteria)
Progressive or recurrent disease per Response Assessment in Neuro-Oncology (RANO) criteria
No IDH mutation (IDH1 R132H negative by immunohistochemistry \[IHC\] or sequencing)
Patients must be in first recurrence of glioblastoma following radiation therapy and temozolomide
No prior therapies except radiation, surgery, temozolomide, Tumor Treating Fields (TTFields), and/or Gliadel wafers (placed during the first surgery at diagnosis of glioblastoma multiforme \[GBM\]). Prior radiation therapy, TTFields, or placement of Gliadel wafers must be completed at least 2 weeks prior to registration. Prior temozolomide must be completed at least 3 weeks prior to registration
No prior use of nivolumab or other anti-PD1 agents
Patients must be neurologically stable off corticosteroids for at least 5 days prior to registration
Age: 18 years
Karnofsky Performance Status: 60% (i.e. patient must be able to care for themselves with occasional help from others)
Absolute lymphocyte count (ALC): 1000/mm\^3
Absolute neutrophil count (ANC): 1500/mm\^3
Platelet count: 100,000/mm\^3
Hemoglobin: 9.0 g/dL
Activated partial thromboplastin time (APTT) or partial thromboplastin time (PTT): 1.5 x upper limit of normal (ULN)
Total bilirubin: 2.0 x ULN (Except for patients with Gilbert's syndrome, who must have direct bilirubin 2.0 x ULN)
Aspartate aminotransferase (AST) / alanine aminotransferase (ALT): 3.0 x ULN
Calculated (calc.) creatinine clearance (CrCl): 50 mL/min * Calculated by Cockcroft-Gault equation
Not pregnant and not nursing, because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown and an agent that has known genotoxic, mutagenic and teratogenic effects. Therefore, for women of childbearing potential only, a negative pregnancy test done within 14 days prior to registration is required
Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
No active brain metastases or leptomeningeal disease
HIV: HIV-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months prior to registration are eligible for this trial
Hepatitis B: For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
Hepatitis C: Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
No known medical condition causing an inability to swallow oral formulations of agents
No current symptomatic pulmonary disease
No autoimmune disorders that require systemic treatment (except hyperthyroidism or diabetes mellitus)
