PRIMARY OBJECTIVE:~I. To determine progression free survival and maintenance of quality of life at 12 months as based on physical function and compared to historical controls.~SECONDARY OBJECTIVES:~I. To identify proportion of participants with visual deficits at 1-year, 2-year, and 3-year follow-up.~II. To identify proportion of participants with neuroendocrine deficits at 1-year, 2-year, and 3-year follow-up.~EXPLORATORY OBJECTIVES:~I. To assess Quality of Life (QOL) and cognitive measures in children and young adults with newly diagnosed or recurrent craniopharyngioma.~II. To perform Immunohistochemistry (IHC)/Multiplexed ion beam imaging on pre-and post-treatment tumor tissue (as available), including at time of progression, to assess for patterns of protein density and spatial relationship in intact tumor tissue and elucidate changes in tumor tissue over the course of therapy and disease evolution.~III. To perform single-cell (scRNA) and single-nucleus (snRNA) RNA sequencing on pre- and post-treatment tumor tissue (as available), including at time of progression, to identify and characterize distinct cell subsets that make up the components of craniopharyngioma and elucidate changes in cell subsets over the course of therapy and disease evolution.~IV. To perform proteomic analysis on pre- and post-treatment tumor tissue, including at time of progression, to characterize distinct proteins and transcriptome pathways that are active in different tumor compartments and elucidate changes in proteomic profiles over the course of therapy and disease evolution.~V. To perform ELISA array/multiplex analysis on pre- and post-treatment cyst fluid, including at time of progression, to characterize distinct cytokine profiles and elucidate changes in cytokine profile over the course of therapy and disease evolution.~VI. Microbiome and flow cytometry studies in the context of imaging and clinical outcomes using descriptive statistic.~TREATMENT GROUPS:~Participants will be divided into 2 Groups (Newly diagnosed craniopharyngioma, Recurrent craniopharyngioma) with 3 treatment arms within each group (Neoadjuvant nivolumab, Neoadjuvant DAY101, Neoadjuvant combination nivolumab plus DAY101). There will also be a separate Non-biopsy/resection arm within the Recurrent Craniopharyngioma group.~Participants will be randomized in a 1:1:1 and will receive one dose of assigned drug prior to planned biopsy or resection. Participants with measurable disease will then continue on combination maintenance therapy. Participants may continue treatment for up to 24 months total and will be followed up 3 years after enrollment into the study.
The current study assesses the tolerability and efficacy of combination therapy with PD-1 (nivolumab) and pan-RAF-kinase (DAY101) inhibition for the treatment of children and young adults with craniopharyngioma.