safety and efficacy of transient opening of the blood-brain barrier (bbb) with the sonocloud-9

Conditions: Glioblastoma, Adult

Summary: recurrent glioblastoma (gbm) is a disease with high unmet clinical need. the standard of care for patients with gbm includes surgery, radiotherapy and chemotherapy. despite this aggressive treatment, the overall median survival of patients with gbm remains at 15-20 months. in more than 95% of cases, tumor recurrence is observed within 2 cm to 3 cm of the resection cavity within 4-7 months after initial treatments. one of the main causes of recurrence is the inability of chemotherapies to enter the brain from the systemic circulation due to the blood-brain barrier (bbb). the bbb is unique to cerebral blood vessels and blocks most drugs from entering the brain in sufficient concentrations. the sonocloud-9 (sc9) system delivers ultrasound to locally and transiently increase the permeability of the bbb to allow the passage of drugs into the cerebral parenchyma. the sc9 is dimensioned to cover the resection area and surrounding tissues in patients with recurrent gbm. the large sonicated volume covered by the sc9 device allows for broad bbb disruption and should allow for carboplatin chemotherapy to penetrate the surrounding tumor infiltrative area. by enhancing drug concentrations, it is hypothesized that further disease progression will be prevented.

this will be an open-label, phase 1/2a, multicenter, single-arm, interventional trial that will first evaluate the dose limiting toxicity (dlt) of escalating numbers of ultrasound beams at constant acoustic pressure using a standard escalation (phase 1) and then confirm the safety and efficacy of bbb opening (phase 2a expansion).

Eligibility criteria:
key inclusion criteria: 1. age ≥ 18 years, able and willing to give signed and informed consent. 2. patient with histologically proven recurrent de novo gbm: 1. after at least a first-line standard of care (maximal safe resection, if feasible, radiation with temozolomide \[tmz\], then tmz); 2. any recurrence; 3. bevacizumab-naïve.\* 3. patient eligible for carboplatin-based chemotherapy. 4. patient eligible for a surgical resection. 5. maximal tumor diameter at inclusion (pre surgery) ≤ 70 mm in t1wmri. 6. patients should be stable, without evidence of a midline shift, significant peritumoral edema, or rapid progression of clinical symptoms. 7. karnofsky performance status ≥ 70. 8. patient receiving prednisone dose ≤ 40 mg (dexamethasone ≤ 6 mg) for at least 7 days. key exclusion criteria: 1. multifocal tumor (unless all localized in a 70 mm diameter area). 2. patients at risk of surgery site infection (2 or more previous craniotomies, neurosurgery within the last 3 months, poor skin condition, and/or previously infected surgical field). 3. posterior fossa tumor. 4. uncontrolled epilepsy. 5. patients with evidence of uncontrolled intracranial pressure. 6. patients with known intracranial aneurism or having presented intra-tumor spontaneous hemorrhage. 7. patients with coils, clips, shunts, intravascular stents, and/or unremovable wafer, non resorbable dura substitute, or reservoirs. 8. patients with medical need to continue antiplatelet therapy. 9. patients with known or suspected active or chronic infections.

Keywords: recurrent glioblastoma carboplatin ultrasound blood-brain barrier glioblastoma sonocloud low intensity pulsed ultrasound (lipu)