Clinical trial NCT03744026: Safety and Efficacy of Transient Opening of the Blood-brain Barrier (BBB) With the SonoCloud-9
Official title: A Study to Evaluate the Safety and the Efficacy of Transient Opening of the Blood-brain Barrier (BBB) by Low Intensity Pulsed Ultrasound With the SonoCloud-9 Implantable Device in Recurrent Glioblastoma Patients Eligible for Surgery and for Carboplatin Chemotherapy
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
PHASE2
Conditions: Glioblastoma, Adult
Keywords: Recurrent Glioblastoma
Carboplatin
Ultrasound
Blood-brain barrier
Glioblastoma
SonoCloud
Low Intensity Pulsed Ultrasound (LIPU)
Lead sponsor: CarThera
Sponsor class: INDUSTRY
First posted: 2018-11-16
Enrollment: 38
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief 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.

Detailed description: 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.

Primary outcomes:
measure: Dose limiting toxicity (DLT) of number of activated ultrasound beams
timeFrame: 15 days after the first sonication treatment
measure: Blood-Brain Barrier (BBB) opening
timeFrame: At the end of the first three sonication treatments (treatment occurs every 4 weeks)
Secondary outcomes:
Other outcomes:
Locations:
city: Chicago
country: United States
facility: Northwestern University
state: Illinois
city: Houston
country: United States
facility: MD Anderson Cancer Center
state: Texas
city: Angers
country: France
facility: CHU
city: Bron
country: France
facility: Hôpital Neurologique Pierre Wertheimer
city: Marseille
country: France
facility: Hôpital de La Timone
city: Paris
country: France
facility: Hôpital de la Pitié-Salpêtrière
Study officials:
affiliation: APHP
name: Ahmed IDBAIH, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Carpentier A, Canney M, Vignot A, Reina V, Beccaria K, Horodyckid C, Karachi C, Leclercq D, Lafon C, Chapelon JY, Capelle L, Cornu P, Sanson M, Hoang-Xuan K, Delattre JY, Idbaih A. Clinical trial of blood-brain barrier disruption by pulsed ultrasound. Sci Transl Med. 2016 Jun 15;8(343):343re2. doi: 10.1126/scitranslmed.aaf6086.