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Efficacy and Safety of NaviFUS System add-on Bevacizumab (BEV) in Recurrent GBM Patients

Primary Purpose

Glioblastoma Multiforme, Glioblastoma, Glioma

Status
Completed
Phase
Not Applicable
Locations
Taiwan
Study Type
Interventional
Intervention
NaviFUS System
Bevacizumab
Sponsored by
NaviFUS Corporation
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Glioblastoma Multiforme focused on measuring NaviFUS System, Blood-Brain Barrier, Focused Ultrasound, GBM, Bevacizumab

Eligibility Criteria

20 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Adult male/female patients ≥ 20 years of age
  2. Patients with histologically confirmed glioblastoma, recurrent after prior radiotherapy and temozolomide chemotherapy.
  3. Patient may have been operated for recurrence. If operated: with measurable residual tumor
  4. Minimum interval since completion of radiation treatment is 12 weeks
  5. Patients if already on the steroids then should be on a stable dose of steroids for at least 7 days prior to study treatment
  6. Body mass index (BMI) ≥17 kg / m2
  7. Minimum interval since last drug therapy:

    • 1 week for non-cytotoxic agents (e.g., interferon, tamoxifen), daily chemotherapy (e.g., metronomic temozolomide, cytoxan) or targeted therapies administered daily (e.g., gleevec, tarceva)
    • 4 weeks since last cytotoxic therapy
    • 6 weeks since the completion of a nitrosourea-containing chemotherapy regimen (e.g., carmustine (BCNU))
  8. Patients with life expectancy ≥ 3 months
  9. The Karnofsky performance status (KPS) in the patient must be > 60
  10. Eastern Cooperative Oncology Group (ECOG) Score ≤ 2
  11. Adequate hepatic, renal, coagulation, and hematopoietic function

    • Hemoglobin ≥ 8 g/dL
    • Platelets ≥ 100,000/mm3
    • Neutrophils ≥ 1,500/mm3
    • Serum creatinine ≤ 1.5 x upper limit of normal (ULN)
    • Urine protein creatinine (UPC) ratio < 1 or urine dipstick for proteinuria ≤ 2+
    • Alanine transaminase (ALT) < 3 ULN
    • Aspartate transaminase (AST) < 3 x ULN
    • Prothrombin time ≤ 1.2 x ULN
    • International Normalized Ratio (INR) < 1.5
    • Bilirubin < 2 x ULN
  12. Patients with the region of interest (ROI) for FUS exposure are located close to the cortex with at least 20 mm distance beneath the skull bone and the ROI is not in the deep center brain with crucial brain functions, such as in the region of brain stem, or motor or speech regions
  13. Patients with the potential for pregnancy and their partner must agree to use adequate contraception or be surgically sterile, or abstain from heterosexual activity starting with the first dose of treatment through at least 6 months after the last dose of BEV to avoid conception. Female patients of child-bearing potential must have a negative pregnancy test. Male patients must agree to use an adequate method of contraception starting with the first dose of treatment through 6 months after the last dose of BEV.
  14. Able to give informed consent for the participation in the trial

Exclusion Criteria:

  1. Patients who have had previous treatment with an inhibitor of vascular endothelial growth factor (VEGF) or VEGFR (including bevacizumab)
  2. New York Heart Association (NYHA) Grade II or greater congestive heart failure requiring hospitalization within 12 months prior to screening
  3. Severe hypertension at screening (diastolic blood pressure > 100 mmHg on medication)
  4. Uncontrolled intercurrent illness including, but not limited to symptomatic congestive heart failure, unstable angina pectoris, severe cerebral or myocardial infarction, cardiac shunt, heart attack within the previous 12 months, stroke (except for transient ischemic attack; TIA) within the previous 6 months, or psychiatric illness/social situations that would limit compliance with study requirements
  5. Unstable pulmonary disease or Chronic Obstructive Pulmonary Disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of screening
  6. Implanted pacemaker, defibrillator or deep brain stimulator, other implanted electronic devices in the brain or documented clinically significant arrhythmias
  7. Major surgery such as intra-thoracic, intra-abdominal or intra-pelvic (with the exception of craniotomy), open biopsy or significant traumatic injury ≤ 4 weeks prior to screening, or patients who have had minor procedures, percutaneous biopsies or placement of vascular access device ≤ 1 week prior to screening, or who have not recovered from side effects of such procedure or injury
  8. Known HIV positive patients, however, that HIV testing is not required for entry into this study
  9. Acute bacterial or fungal infection requiring intravenous antibiotics at the time of screening
  10. Receiving anticoagulant (e.g. warfarin) or antiplatelet (e.g. aspirin) therapy within one week prior to beginning treatment
  11. Pregnant or breast-feeding women
  12. Known sensitivity/allergy to PET tracers, Magnetic Resonance Imaging (MRI) contrast agents, Computer Tomography (CT) contrast agents, SonoVue®, bevacizumab, or any of their components
  13. Abnormal baseline findings considered by the investigator to indicate conditions that might affect study endpoints
  14. Patients who have hemorrhage or cyst within the ROI
  15. The receipt of an investigational drug within a period of 4 weeks prior to the first FUS exposure
  16. Use of any recreational drugs or history of drug addiction
  17. Any other condition that, in the investigator's judgment, might increase the risk to the patients or decrease the chance of obtaining satisfactory data needed to achieve the objectives of the study

Sites / Locations

  • Linkou Chang Gung Memorial Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Bevacizumab plus NaviFUS System

Arm Description

Device: NaviFUS System BBB Disruption by FUS in recurrent GBM Microbubbles (MB) (SonoVue®) 0.1 mL/kg and optimal ultrasound exposure doses (based on the acoustic emission feedback FUS power control algorithm) generated from the NaviFUS System every 2 weeks to transiently open the BBB. Drug: Bevacizumab 10 mg/kg every 2 weeks for up to 36 weeks or until evidence of progressive disease, unacceptable toxicity, non-compliance with study follow-up, or withdrawal of consent.

Outcomes

Primary Outcome Measures

Adverse Event
Number and severity of adverse event
Progression-free survival at 6 months (PFS-6)
Estimated rate of patients treated during 6 months without experiencing disease

Secondary Outcome Measures

Tumor shrinkage
The tumor shrinkage rate (TSR) by measuring the longest diameter and perpendicular diameter of the main mass on MRI scans
Objective response rate (ORR)
Proportion of subjects in the analysis population who have complete response (CR) or partial response (PR) using Radiologic Assessment in Neuro-Oncology criteria (RANO) criteria
PET uptake
The uptake of PET (as standard uptake value - SUV and tumor-to-background ratio - TBR) in tumor and in normal contralateral gray matter before start of BEV+FUS treatment will be determined.
Overall survival (OS)
OS is defined as the time in months from study treatment to death or last follow-up if alive from any cause
Degree of the BBB opening
The FUS with microbubbles can temporally open the BBB. The spatial permeability of the BBB-opened region will be assessed using dynamic contrast-enhanced MRI (DCE-MRI).
Corticosteroid consumption
Increase or decrease in corticosteroid use compared to baseline. The mean corticosteroid dosage prior to study treatment will be considered as the patient's baseline.
Quality of life (QoL) assessment with the EORTC QLQ-C30
The validated European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-C30) will be used. The EORTC QLQ-C30 is a 30-item questionnaire. All of the response scale to questions are rated on a 4-point Likert scale from 1 = not at all, 2 = a little, 3 = quite a bit, to 4 = very much, and are linearly transformed to a 0-100 scale, with higher scores indicating more severe symptoms.
Quality of life (QoL) assessment with the EORTC QLQ-BN20
The EORTC QLQ-BN20 is a QoL assessment specific to brain neoplasms. The questionnaire includes 20 items. All of the response scale to questions are rated on a 4-point Likert scale from 1 = not at all, 2 = a little, 3 = quite a bit, to 4 = very much, and are linearly transformed to a 0-100 scale, with higher scores indicating more severe symptoms.

Full Information

First Posted
June 16, 2020
Last Updated
September 4, 2023
Sponsor
NaviFUS Corporation
Collaborators
Chang Gung Memorial Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT04446416
Brief Title
Efficacy and Safety of NaviFUS System add-on Bevacizumab (BEV) in Recurrent GBM Patients
Official Title
An Open Label, Prospective, Pilot Study to Evaluate the Efficacy and Safety of Best Physician's Choice of Standard of Care Combined With NaviFUS System in Patients With Recurrent Glioblastoma Multiforme
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Completed
Study Start Date
July 21, 2020 (Actual)
Primary Completion Date
September 30, 2022 (Actual)
Study Completion Date
August 4, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
NaviFUS Corporation
Collaborators
Chang Gung Memorial Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a prospective, single-arm, two stages, open-label, pilot study to investigate the efficacy and safety of FUS add-on bevacizumab (BEV) in rGBM patients. The BEV is the best physician's choice of standard of care for rGBM after prior radiotherapy and temozolomide chemotherapy in the LinKou Chang Gung Memorial Hospital. Eligible patients will be enrolled through the process of informed consent.
Detailed Description
This trial will be divided into two stages. The study design and procedures will be as follows: Stage 1: Eligible patients will first be administered with BEV 10 mg/kg intravenous (IV) infusion. After 30-60 minutes, patients will receive microbubbles (MB) (SonoVue®) 0.1 mL/kg and optimal ultrasound exposure doses (based on the acoustic emission feedback FUS power control algorithm) generated from the NaviFUS System single exposure unit for up to two minutes every 2 weeks to transiently open the BBB. After 4 weeks of treatment with BEV and single unit FUS-MB treatment, if the patient experienced BBB opening using FUS treatment and BEV IV infusion without any serious adverse effects (such as brain significant bleeding), then the patient may proceed to stage 2. Stage 2: Patients who complete stage 1 will enter stage 2 to receive the BEV with MB-mediated multiple units of FUS treatment for up to five minutes (but the maximum exposure time per single unit is two minutes) every 2 weeks for up to 30 weeks or until evidence of progressive disease, unacceptable toxicity, non-compliance with study follow-up, or withdrawal of consent. After completion of study treatment, patients will be followed up for 28 days.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Glioblastoma Multiforme, Glioblastoma, Glioma, Brain Tumor, Neoplasms, Neoplasms, Nerve Tissue
Keywords
NaviFUS System, Blood-Brain Barrier, Focused Ultrasound, GBM, Bevacizumab

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
6 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Bevacizumab plus NaviFUS System
Arm Type
Experimental
Arm Description
Device: NaviFUS System BBB Disruption by FUS in recurrent GBM Microbubbles (MB) (SonoVue®) 0.1 mL/kg and optimal ultrasound exposure doses (based on the acoustic emission feedback FUS power control algorithm) generated from the NaviFUS System every 2 weeks to transiently open the BBB. Drug: Bevacizumab 10 mg/kg every 2 weeks for up to 36 weeks or until evidence of progressive disease, unacceptable toxicity, non-compliance with study follow-up, or withdrawal of consent.
Intervention Type
Device
Intervention Name(s)
NaviFUS System
Intervention Description
Open the BBB using focused ultrasound and contrast agent SonoVue®
Intervention Type
Drug
Intervention Name(s)
Bevacizumab
Other Intervention Name(s)
Avastin
Intervention Description
An anti-angiogenic agent to block tumor growth
Primary Outcome Measure Information:
Title
Adverse Event
Description
Number and severity of adverse event
Time Frame
38 weeks
Title
Progression-free survival at 6 months (PFS-6)
Description
Estimated rate of patients treated during 6 months without experiencing disease
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Tumor shrinkage
Description
The tumor shrinkage rate (TSR) by measuring the longest diameter and perpendicular diameter of the main mass on MRI scans
Time Frame
38 weeks
Title
Objective response rate (ORR)
Description
Proportion of subjects in the analysis population who have complete response (CR) or partial response (PR) using Radiologic Assessment in Neuro-Oncology criteria (RANO) criteria
Time Frame
38 weeks
Title
PET uptake
Description
The uptake of PET (as standard uptake value - SUV and tumor-to-background ratio - TBR) in tumor and in normal contralateral gray matter before start of BEV+FUS treatment will be determined.
Time Frame
38 weeks
Title
Overall survival (OS)
Description
OS is defined as the time in months from study treatment to death or last follow-up if alive from any cause
Time Frame
38 weeks
Title
Degree of the BBB opening
Description
The FUS with microbubbles can temporally open the BBB. The spatial permeability of the BBB-opened region will be assessed using dynamic contrast-enhanced MRI (DCE-MRI).
Time Frame
38 weeks
Title
Corticosteroid consumption
Description
Increase or decrease in corticosteroid use compared to baseline. The mean corticosteroid dosage prior to study treatment will be considered as the patient's baseline.
Time Frame
38 weeks
Title
Quality of life (QoL) assessment with the EORTC QLQ-C30
Description
The validated European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-C30) will be used. The EORTC QLQ-C30 is a 30-item questionnaire. All of the response scale to questions are rated on a 4-point Likert scale from 1 = not at all, 2 = a little, 3 = quite a bit, to 4 = very much, and are linearly transformed to a 0-100 scale, with higher scores indicating more severe symptoms.
Time Frame
38 weeks
Title
Quality of life (QoL) assessment with the EORTC QLQ-BN20
Description
The EORTC QLQ-BN20 is a QoL assessment specific to brain neoplasms. The questionnaire includes 20 items. All of the response scale to questions are rated on a 4-point Likert scale from 1 = not at all, 2 = a little, 3 = quite a bit, to 4 = very much, and are linearly transformed to a 0-100 scale, with higher scores indicating more severe symptoms.
Time Frame
38 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adult male/female patients ≥ 20 years of age Patients with histologically confirmed glioblastoma, recurrent after prior radiotherapy and temozolomide chemotherapy. Patient may have been operated for recurrence. If operated: with measurable residual tumor Minimum interval since completion of radiation treatment is 12 weeks Patients if already on the steroids then should be on a stable dose of steroids for at least 7 days prior to study treatment Body mass index (BMI) ≥17 kg / m2 Minimum interval since last drug therapy: 1 week for non-cytotoxic agents (e.g., interferon, tamoxifen), daily chemotherapy (e.g., metronomic temozolomide, cytoxan) or targeted therapies administered daily (e.g., gleevec, tarceva) 4 weeks since last cytotoxic therapy 6 weeks since the completion of a nitrosourea-containing chemotherapy regimen (e.g., carmustine (BCNU)) Patients with life expectancy ≥ 3 months The Karnofsky performance status (KPS) in the patient must be > 60 Eastern Cooperative Oncology Group (ECOG) Score ≤ 2 Adequate hepatic, renal, coagulation, and hematopoietic function Hemoglobin ≥ 8 g/dL Platelets ≥ 100,000/mm3 Neutrophils ≥ 1,500/mm3 Serum creatinine ≤ 1.5 x upper limit of normal (ULN) Urine protein creatinine (UPC) ratio < 1 or urine dipstick for proteinuria ≤ 2+ Alanine transaminase (ALT) < 3 ULN Aspartate transaminase (AST) < 3 x ULN Prothrombin time ≤ 1.2 x ULN International Normalized Ratio (INR) < 1.5 Bilirubin < 2 x ULN Patients with the region of interest (ROI) for FUS exposure are located close to the cortex with at least 20 mm distance beneath the skull bone and the ROI is not in the deep center brain with crucial brain functions, such as in the region of brain stem, or motor or speech regions Patients with the potential for pregnancy and their partner must agree to use adequate contraception or be surgically sterile, or abstain from heterosexual activity starting with the first dose of treatment through at least 6 months after the last dose of BEV to avoid conception. Female patients of child-bearing potential must have a negative pregnancy test. Male patients must agree to use an adequate method of contraception starting with the first dose of treatment through 6 months after the last dose of BEV. Able to give informed consent for the participation in the trial Exclusion Criteria: Patients who have had previous treatment with an inhibitor of vascular endothelial growth factor (VEGF) or VEGFR (including bevacizumab) New York Heart Association (NYHA) Grade II or greater congestive heart failure requiring hospitalization within 12 months prior to screening Severe hypertension at screening (diastolic blood pressure > 100 mmHg on medication) Uncontrolled intercurrent illness including, but not limited to symptomatic congestive heart failure, unstable angina pectoris, severe cerebral or myocardial infarction, cardiac shunt, heart attack within the previous 12 months, stroke (except for transient ischemic attack; TIA) within the previous 6 months, or psychiatric illness/social situations that would limit compliance with study requirements Unstable pulmonary disease or Chronic Obstructive Pulmonary Disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of screening Implanted pacemaker, defibrillator or deep brain stimulator, other implanted electronic devices in the brain or documented clinically significant arrhythmias Major surgery such as intra-thoracic, intra-abdominal or intra-pelvic (with the exception of craniotomy), open biopsy or significant traumatic injury ≤ 4 weeks prior to screening, or patients who have had minor procedures, percutaneous biopsies or placement of vascular access device ≤ 1 week prior to screening, or who have not recovered from side effects of such procedure or injury Known HIV positive patients, however, that HIV testing is not required for entry into this study Acute bacterial or fungal infection requiring intravenous antibiotics at the time of screening Receiving anticoagulant (e.g. warfarin) or antiplatelet (e.g. aspirin) therapy within one week prior to beginning treatment Pregnant or breast-feeding women Known sensitivity/allergy to PET tracers, Magnetic Resonance Imaging (MRI) contrast agents, Computer Tomography (CT) contrast agents, SonoVue®, bevacizumab, or any of their components Abnormal baseline findings considered by the investigator to indicate conditions that might affect study endpoints Patients who have hemorrhage or cyst within the ROI The receipt of an investigational drug within a period of 4 weeks prior to the first FUS exposure Use of any recreational drugs or history of drug addiction Any other condition that, in the investigator's judgment, might increase the risk to the patients or decrease the chance of obtaining satisfactory data needed to achieve the objectives of the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kuo-Chen Wei, M.D.
Organizational Affiliation
Chang Gung Memorial Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Linkou Chang Gung Memorial Hospital
City
Taoyuan City
ZIP/Postal Code
33305
Country
Taiwan

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
27192459
Citation
Liu HL, Hsu PH, Lin CY, Huang CW, Chai WY, Chu PC, Huang CY, Chen PY, Yang LY, Kuo JS, Wei KC. Focused Ultrasound Enhances Central Nervous System Delivery of Bevacizumab for Malignant Glioma Treatment. Radiology. 2016 Oct;281(1):99-108. doi: 10.1148/radiol.2016152444. Epub 2016 May 18.
Results Reference
background
PubMed Identifier
19720927
Citation
Friedman HS, Prados MD, Wen PY, Mikkelsen T, Schiff D, Abrey LE, Yung WK, Paleologos N, Nicholas MK, Jensen R, Vredenburgh J, Huang J, Zheng M, Cloughesy T. Bevacizumab alone and in combination with irinotecan in recurrent glioblastoma. J Clin Oncol. 2009 Oct 1;27(28):4733-40. doi: 10.1200/JCO.2008.19.8721. Epub 2009 Aug 31.
Results Reference
background
PubMed Identifier
19114704
Citation
Kreisl TN, Kim L, Moore K, Duic P, Royce C, Stroud I, Garren N, Mackey M, Butman JA, Camphausen K, Park J, Albert PS, Fine HA. Phase II trial of single-agent bevacizumab followed by bevacizumab plus irinotecan at tumor progression in recurrent glioblastoma. J Clin Oncol. 2009 Feb 10;27(5):740-5. doi: 10.1200/JCO.2008.16.3055. Epub 2008 Dec 29.
Results Reference
background
PubMed Identifier
30674905
Citation
Mainprize T, Lipsman N, Huang Y, Meng Y, Bethune A, Ironside S, Heyn C, Alkins R, Trudeau M, Sahgal A, Perry J, Hynynen K. Blood-Brain Barrier Opening in Primary Brain Tumors with Non-invasive MR-Guided Focused Ultrasound: A Clinical Safety and Feasibility Study. Sci Rep. 2019 Jan 23;9(1):321. doi: 10.1038/s41598-018-36340-0.
Results Reference
background
PubMed Identifier
31076548
Citation
Sonabend AM, Stupp R. Overcoming the Blood-Brain Barrier with an Implantable Ultrasound Device. Clin Cancer Res. 2019 Jul 1;25(13):3750-3752. doi: 10.1158/1078-0432.CCR-19-0932. Epub 2019 May 10.
Results Reference
background

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Efficacy and Safety of NaviFUS System add-on Bevacizumab (BEV) in Recurrent GBM Patients

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