Nivolumab With Radiation Therapy and Bevacizumab for Recurrent MGMT Methylated Glioblastoma

Inclusion Criteria: * Histologic confirmed glioblastoma (WHO grade IV), IDH wildtype confirmed by DNA sequencing * MGMT hypermethylation in archival tumor biopsy, determined by any CLIAapproved, DNA-based assay * Prior maximal feasible surgical resection of biopsy * Prior treatment with radiation and temozolomide chemotherapy * Pathologic and/or Radiographic evidence of recurrent disease * Circumscribed enhancing tumor ≤ 5.0 cm in largest diameter (T1 post contrast) * 1 prior course of radiation therapy * Age ≥ 18 years * Karnofsky performance status ≥ 70% or ECOG 0 or 1 * Adequate bone marrow function * Hemoglobin ≥ 10g/dL * Absolute neutrophil count ≥ 1,500/mm 3 * Absolute lymphocyte count ≥ 200/mm 3 * Platelet count ≥ 100,000/mm3 * Adequate liver function * Bilirubin \<1.5 times upper limit normal (ULN) * AST and ALT ≤ 3 times ULN * Alkaline phosphatase ≤ 2 times ULN * Adequate renal function * BUN and Creatinine \<1.5 times ULN Exclusion Criteria: * Infratentorial location of the recurrence * IDH mutated glioblastoma * More than one prior tumor recurrence after standard first-line therapy * Prior radiation to the brain within ≤ 4 months * Circumscribed enhancing tumor \>5.0 cm in largest diameter (T1 post contrast) * Pulmonary embolus or deep vein thrombosis within preceding 2 months * Grade 2 or greater congestive heart failure * Unstable angina, myocardial infarction within past 12 months * Peptic ulcer, abdominal fistula, gastrointestinal perforat…