Neoantigen-based Personalized Vaccine Combined With Immune Checkpoint Blockade Therapy in Patients With Newly Diagnosed, Unmethylated Glioblastoma

Inclusion Criteria:

• Newly diagnosed histologically confirmed unmethylated glioblastoma multiforme (WHOgrade IV). Patients with secondary glioblastoma, in particular those who are IDH1 orIDH2 mutant, will not be excluded. Unmethylated MGMT must be confirmed by a PCR-basedassay.
• Patients who had craniotomy with biopsy, subtotal resection, total gross resection, orre-resection will be permitted.
• Consented to genome sequencing and dbGaP-based data sharing and has provided or willprovide germline (PBMC) and tumor DNA/RNA samples of adequate quality for sequencing. (Acquisition of specimens for sequencing and the sequencing itself may be done as partof routine care or another research project.)
• At least 18 years of age.
• Karnofsky performance status ≥ 60%
• Normal bone marrow and organ function as defined below:
• Absolute neutrophil count ≥ 1,500/mcL
• Platelets ≥ 100,000/mcL
• Total bilirubin ≤ 1.5 x institutional upper limit of normal (IULN)
• AST(SGOT)/ALT(SGPT) ≤ 3.0 x IULN
• Creatinine ≤ IULN OR creatinine clearance ≥ 60 mL/min/1.73 m2 for patients withcreatinine levels above institutional normal
• Systemic corticosteroid therapy is permitted provided dosing is no greater than 4 mgper day (dexamethasone or equivalent) on the day of vaccine administration.
• Bevacizumab will be allowed if given for symptomatic control of vasogenic edema and toavoid high dose of corticosteroids.
• Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and forthe duration of study participation, including at least 5 months (for women ofchildbearing potential) and at least 7 months (for men) after last dose of study drug.Should a woman become pregnant or suspect she is pregnant while participating in thisstudy, she must inform her treating physician immediately.
• Ability to understand and willingness to sign an IRB approved written informed consentdocument (or that of legally authorized representative, if applicable).

Exclusion Criteria:

• As this study aims to assess the immunogenicity of various vaccine plus adjuvantcombinations, no prior immunotherapy will be permitted.
• Inadequate tissue acquisition to allow for neoantigen screening.
• No candidate neoantigen identified during screening.
• A history of other malignancy ≤ 3 years previous with the exception of non-melanomaskin cancer, any in situ cancer that has been successfully resected and cured, treatedsuperficial bladder cancer, or any early-stage solid tumor that was successfullyresected without need for adjuvant radiation or chemotherapy.
• Receiving any other investigational agents within 4 weeks of beginning studytreatment.
• Known allergy, or history of serious adverse reaction to, vaccines such asanaphylaxis, hives, or respiratory difficulty.
• A history of allergic reactions attributed to compounds of similar chemical orbiologic composition to poly-ICLC or other agents used in the study.
• Uncontrolled intercurrent illness including, but not limited to, ongoing or activeinfection, symptomatic congestive heart failure, unstable angina pectoris, cardiacarrhythmia, or psychiatric illness/social situations that would limit compliance withstudy requirements.
• History of pre-existing immunodeficiency disorder or autoimmune condition requiringimmunosuppressive therapy. This includes inflammatory bowel disease, ulcerativecolitis, Crohn's disease, systemic vasculitis, scleroderma, psoriasis, multiplesclerosis, hemolytic anemia, immune-mediated thrombocytopenia, rheumatoid arthritis,systemic lupus erythematosus, Sjögren's syndrome, sarcoidosis, or other rheumatologicdisease or any other medical condition or use of medication which might make itdifficult for the patient to complete the full course of treatments or to generate animmune response to vaccines.
• Presence of clinically significant increased intracranial pressure (e.g. impendingherniation) or hemorrhage, uncontrolled seizures, or requirement for immediatepalliative treatment.
• Pregnant and/or breastfeeding. Women of childbearing potential must have a negativepregnancy test within 7 days of first dose of vaccine.