ExAblate Blood Brain Barrier Disruption (BBBD) for Planned Surgery in Suspected Infiltrating Glioma

Study Overview
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Brief Summary
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This study is designed to assess the safety and feasibility of using the ExAblate, Type 2 to temporarily disrupt the blood brain barrier in non-enhancing suspected infiltrating glioma. The ExAblate Model 4000 Type-2 is intended for use as a tool to disrupt the BBB.

Detailed Description
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This study is a prospective, single-arm, non-randomized, open-label feasibility study to evaluate the safety of focal BBBD using the ExAblate® 4000 Type 2 system. Up to 15 subjects with suspected infiltrating glioma who are scheduled to undergo brain tumor resection may be recruited for the study. Only patients that have a non-enhancing tumor components in a non-eloquent region of the planned standard-of-care resection volume will be eligible. Up to 4 centers may participate in this study.

Official Title
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A Study to Evaluate the Safety and Feasibility of Exablate Model 4000 Type-2 to Temporarily Mediate Blood-Brain Barrier Disruption (BBBD) in Patients With Suspected Infiltrating Glioma in the Setting of Planned Surgical Interventions

Conditions
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Glioma

Intervention / Treatment
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* Device: ExAblate 4000 - Type 2


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or Female between 21-85 years of age Able and willing to give informed consent Subjects with suspected infiltrating glioma on pre-operative brain imaging scans including non-enhancing MRI tumor components in non-eloquent regions that are within the planned surgical resection volume Surgical area targeted for ExAblate treatment (i.e. prescribed Region of Treatment) ≤30 cm3; planned surgical resection volume may exceed the targeted treatment volume Karnofsky Performance Score 70-100 Able to communicate sensations during the ExAblate® BBBD procedure Exclusion Criteria: MRI or clinical findings of: Active or chronic infection(s) or inflammatory processes Acute or chronic hemorrhages, specifically any lobar microbleeds, and no siderosis, amyloid angiopathy, or macrohemorrhages Intracranial thrombosis, vascular malformation, cerebral aneurysm or vasculitis Evidence of tumor-related calcification, cyst, or hemorrhage Midline shift of >10mm or evidence of subfalcine, uncal, or tonsillar herniation on pre-operative imaging More than 30% of the skull area traversed by the sonication pathway is covered by scars, scalp disorders (e.g., eczema), or atrophy of the scalp Clips, shunts, or any metallic implanted objects in the skull or the brain or the presence of unknown MR unsafe devices anywhere within the body Significant cardiac disease or unstable hemodynamic status Uncontrolled hypertension (systolic > 150 and diastolic BP > 100 on medication) Receiving anticoagulant (e.g. warfarin) or antiplatelet (e.g. aspirin) therapy within one week of focused ultrasound procedure or drugs known to increase risk of hemorrhage (e.g. Avastin) within one month of focused ultrasound procedure History of a liver disease, bleeding disorder, coagulopathy or a history of spontaneous hemorrhage Abnormal coagulation profile (Platelets < 100,000), PT (>14) or PTT (>36), and INR > 1.3 Lacunar lesions or evidence of increased risk of bleeding Known cerebral or systemic vasculopathy Significant depression and at potential risk of suicide Known sensitivity/allergy to gadolinium, or other intravascular contrast agents Active seizures despite medication treatment (defined as >1 seizure per month) which could be worsened by disruption of the blood brain barrier Evidence of worsening neurological function Dexamethasone dose ≥ 24mg daily or equivalent steroid dose History of drug or alcohol disorder which have a higher risk for seizures, infection and/or poor executive functioning Positive HIV status, which can lead to increased entry of HIV into the brain parenchyma leading to HIV encephalitis Potential blood-borne infections which can lead to increased entry to brain parenchyma leading to meningitis or brain abscess Any contraindications to MRI scanning, including: Large subjects not fitting comfortably into the scanner Difficulty lying supine and still for up to 3 hours in the MRI unit or claustrophobia Untreated, uncontrolled sleep apnea Impaired renal function with estimated glomerular filtration rate <30 mL/min/1.73m2 Respiratory: chronic pulmonary disorders e.g. severe emphysema, pulmonary vasculitis, or other causes of reduced pulmonary vascular cross-sectional area, patients with a history of drug allergies, asthma or hay fever, and multiple allergies where the benefit/risk of administering Definity® is considered unfavorable by the study physicians in relation to the product labeling for Definity Currently in a clinical trial involving an investigational product or non-approved use of a drug or device

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: ExAblate 4000 - Type 2<br>ExAblate BBBD | Device: ExAblate 4000 - Type 2<br>* Using ExAblate Model 4000 Type-2 to temporarily disrupt the blood brain barrier in non-enhancing suspected infiltrating glioma undergoing resection<br>* Other names: ExAblate BBBD;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Device and procedure related adverse events | The number and severity of device and BBBD procedure related adverse events will be evaluated. | At the time of the ExAblate MRgFUS procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility of BBB disruption | The extent and reversibility of BBB opening will be determined by the degree of contrast enhancement seen on post-procedure MRI with contrast agent | At the time of the ExAblate MRgFUS procedure and 24 hours post-procedure | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Glioblastoma, Blood Brain Barrier, BBB, ExAblate, Blood Brain Barrier Disruption, Infiltrating glioma