A Single center, Open-Label, Randomized Study to Evaluate the Safety and Efficacy of neoadjuvant and adjuvant Pembrolizumab on top of standard Chemo-Radiotherapy (Stupp protocol) in Treatment of Patients with newly diagnosed Glioblastoma Multiforme (GBM). (PIRG)

Prior treatment

• Any active concomitant malignancy, except: a. Locally treated basal or squamous cell carcinoma b. Cervical carcinoma in situ c. Breast cancer in situ d. Bladder cancer in situ e. Low grade prostate cancer (under observation with PSA level in normal range)
• Any drug or psychoactive substance dependence
• Evidence of significant uncontrolled concomitant disease that could affect compliance with the protocol
• Treatment with any other investigational agent or participation in another clinical trial with therapeutic intent within 28 days prior to study treatment initiation
• Major surgical procedure within 4 weeks prior to study enrollment or anticipation of need for a major surgical procedure during the course of the study other than for diagnosis
• Any live vaccination within 30 days before enrollment
• Any previous systemic cancer treatment, including, but not limited to: a. Radiotherapy b. Brachytherapy for brain tumor c. Chemotherapy d. Carmustine wafer treatment (Gliadel®) e. Any immune checkpoint inhibitor therapy or any anticancer vaccination
• Tumor other than glioblastoma grade 4 IDH-wildtype, astrocytoma grade 3 or 4 IDH-mutant identified in post-surgery histopathology.
• Any active immunosuppressive systemic therapy (except corticosteroids less or equal to 12mg of dexamethasone equivalent; the dose of dexamethasone should be kept as low as possible throughout the whole duration of this trial)

Other illness

• History of tuberculosis
• Any mental disorder that may affect patient's participation
• Any active immunosuppressive systemic infection including history of human immunodeficiency virus (HIV) infection
• Hypersensitivity or allergy to any substance with similar action mechanism to Pembrolizumab, Atezolizumab, Temozolomide, other monoclonal antibodies or contrast agents
• Any active autoimmune disease or systemic therapy for autoimmune disease within 2 years before enrollment
• History of any immunodeficiency
• Active infection
• Significant cardiovascular disease, such as New York Heart Association cardiac disease ≥ Class III, myocardial infarction within 3 months, coronary artery disease, unstable arrhythmias or unstable angina
• Active liver disease, hepatitis, HBV or HCV infection

Lab values

• Pregnant or lactating or intending to become pregnant during the study – women who are not postmenopausal (postmenopausal defined as ≥ 12 months of non-drug-induced amenorrhea) or surgically sterile must have a negative serum pregnancy test result within 2 weeks prior to initiation of study treatment
• Any condition that the patient's physician determines to be detrimental to the patient participating in this study; including any clinically important deviations from normal clinical laboratory values or concurrent medical events

Other

• Body mass index (BMI) ≥ 35 kg/m2
• Inability to understand the local language for use of the patient QoL instruments
• Presence of 1p19q codeletion

• Signed Informed Consent Form
• For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use double barrier contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 120 days after the last immuno-PET imaging.
• For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use double barrier contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 120 days after the last immuno-PET imaging.
• Age ≥ 18 years
• Age ≤70 years
• Able to comply with the study protocol in the investigator’s judgment
• Clinically and radiologically (contrast CT, full profile MRI – T1-weighted with or without contrast, T2-weighted, FLAIR, DWI, PWI, MR-spectroscopy) confirmed diagnosis of GBM, localized outside eloquent brain areas
• Resectable tumor
• Fully physically active ≥80 points in Karnofsky performance scale
• Life expectancy of at least 3 months
• Adequate organ function (confirmed within 1 weeks before enrollment):a) Hemoglobin ≥ 9g/dL , b) Absolute Neutrophils Count (ANC) ≥1.5×10^9/L, c) White Blood Cells (WBC) count ≥3×10^9/L, d) Platelets (PTL) ≥ 100×10^9/L, e) AST/ALT ≤2.5×ULN, f) Serum creatinine (S-Cr) ≤ ULN, g) Glomerular Filtration Rate (GFR) ≥50mL/min, h) Albumin ≥ LLN , i) Bilirubin ≤ 1.5 ULN (except patients with documented Gilbert’s Syndrome, who must present adequate level of direct bilirubin),j) International normalized ratio (INR) and activated partial thromboplastin time (aPTT) ≤ 1.5×ULN. (Elevation of INR and aPTT due to administration of anticoagulation drugs is not a contraindication for the enrollment. However, it must return to normal range prior to surgery).