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Safety of BBB Disruption Using NaviFUS System in Recurrent Glioblastoma Multiforme (GBM) Patients

Primary Purpose

Glioblastoma Multiforme, Brain Tumor, Glioblastoma

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

About this trial

This is an interventional device feasibility trial for Glioblastoma Multiforme focused on measuring BBB disruption, NaviFUS System, Focused Ultrasound, GBM

Eligibility Criteria

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

Inclusion Criteria:

  • Patients diagnosed with recurrent GBM and will undergo surgery
  • Able to give written informed consent for the participation in the trial
  • Adult male/female patients > 20 years of age
  • Patients if already on radiotherapy, a gap of 7 days shall be maintained between the last day of radiotherapy and the day of screening
  • Patients if already on the steroids treatment, then should be on a stable dose of steroids for at least 7 days prior to screening
  • Body mass index (BMI) ≥17 kg / m2
  • Patients with life expectancy ≥ 3 months
  • Able to comply with study requirements in the opinion of the investigator
  • Adequate hepatic, renal, coagulation, and hematopoietic function

    • Hemoglobin ≥ 10 g/dL
    • Platelets ≥ 100,000/mm3
    • Neutrophils ≥ 1,500/mm3
    • Normal creatinine clearance ≥ 50mL/min
    • Alanine transaminase (ALT) < 3 x upper limit of normal (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 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
  • The Karnofsky performance status (KPS) in the patient must be > 60

Exclusion Criteria:

  • Patients at screening visit have arteriovenous malformation (AVM) or cerebral aneurysm
  • Use of any recreational drugs or history of drug addiction
  • Pregnant or breast-feeding women
  • The receipt of an investigational drug, or participation in a drug research study within a period of one month prior to the first FUS exposure
  • Known sensitivity/allergy to MRI contrast agents, CT contrast agents, SonoVue®, or any of its components
  • 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
  • Abnormal baseline findings considered by the investigator to indicate conditions that might affect study endpoints
  • Patients who have hemorrhage or cyst within the ROI
  • Severe hypertension at screening (diastolic blood pressure > 100 mmHg on medication)
  • Receiving anticoagulant (e.g. warfarin) or antiplatelet (e.g. aspirin) therapy within one week prior to study treatment or drugs known to increase risk or hemorrhage (e.g. Avastin) within one month prior to study treatment

Sites / Locations

  • Linkou Chang Gung Memorial Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

NaviFUS System

Arm Description

NaviFUS System: dose escalation focus ultrasound to transiently disrupt BBB

Outcomes

Primary Outcome Measures

Number and severity of AE
Safety of transient opening of the BBB by using the NaviFUS System

Secondary Outcome Measures

Tolerated dose of FUS with the NaviFUS System for transient disruption of the BBB
Dose escalation study using FUS
Quantify the BBB disruption following BBB disruption by the NaviFUS System
Dynamic T1 contrast-enhanced MRI

Full Information

First Posted
August 7, 2018
Last Updated
June 20, 2019
Sponsor
NaviFUS Corporation
Collaborators
Chang Gung Memorial Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT03626896
Brief Title
Safety of BBB Disruption Using NaviFUS System in Recurrent Glioblastoma Multiforme (GBM) Patients
Official Title
A FIH Feasibility Study to Evaluate the Safety of Transient Disruption of Blood-brain Barrier in Recurrent Glioblastoma Multiforme (GBM) Patients Using NaviFUS System
Study Type
Interventional

2. Study Status

Record Verification Date
August 2018
Overall Recruitment Status
Completed
Study Start Date
August 17, 2018 (Actual)
Primary Completion Date
May 20, 2019 (Actual)
Study Completion Date
June 19, 2019 (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 study is to evaluate the safety and find the tolerated ultrasound dose of transient opening of the blood-brain barrier (BBB) by using the NaviFUS System in recurrent GBM patients.
Detailed Description
This is a feasibility, open-label, single-arm, and dose escalation study. Eligible patients will be enrolled through the process of informed consent. Patients will be assigned into different dose groups generated from the NaviFUS System to transiently open the BBB in patients with recurrent GBM who will undergo surgery within 2 weeks. The focused ultrasound (FUS) dose is selected based on the results of pre-clinical Good Laboratory Practice (GLP) safety studies as well as other non-GLP primate studies. This study will evaluate the safety and the tolerated ultrasound dose of temporary disruption of the BBB in patients with recurrent GBM. To find the tolerated ultrasound dose, the data and safety monitoring board (DSMB) will review the study data and provide the recommendations regarding continuation, termination, or other modifications of the study based on evaluation of observed adverse effects of the intervention. The extent and magnitude of BBB opening will be evaluated using of dynamic contrast-enhanced MRI (DCE-MRI).

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Device Feasibility
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
NaviFUS System
Arm Type
Experimental
Arm Description
NaviFUS System: dose escalation focus ultrasound to transiently disrupt BBB
Intervention Type
Device
Intervention Name(s)
NaviFUS System
Intervention Description
BBB Disruption by FUS in recurrent GBM Other Name: Neuronavigation-guided focus ultrasound system
Primary Outcome Measure Information:
Title
Number and severity of AE
Description
Safety of transient opening of the BBB by using the NaviFUS System
Time Frame
45 days
Secondary Outcome Measure Information:
Title
Tolerated dose of FUS with the NaviFUS System for transient disruption of the BBB
Description
Dose escalation study using FUS
Time Frame
7 days post-FUS
Title
Quantify the BBB disruption following BBB disruption by the NaviFUS System
Description
Dynamic T1 contrast-enhanced MRI
Time Frame
1 day

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients diagnosed with recurrent GBM and will undergo surgery Able to give written informed consent for the participation in the trial Adult male/female patients > 20 years of age Patients if already on radiotherapy, a gap of 7 days shall be maintained between the last day of radiotherapy and the day of screening Patients if already on the steroids treatment, then should be on a stable dose of steroids for at least 7 days prior to screening Body mass index (BMI) ≥17 kg / m2 Patients with life expectancy ≥ 3 months Able to comply with study requirements in the opinion of the investigator Adequate hepatic, renal, coagulation, and hematopoietic function Hemoglobin ≥ 10 g/dL Platelets ≥ 100,000/mm3 Neutrophils ≥ 1,500/mm3 Normal creatinine clearance ≥ 50mL/min Alanine transaminase (ALT) < 3 x upper limit of normal (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 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 The Karnofsky performance status (KPS) in the patient must be > 60 Exclusion Criteria: Patients at screening visit have arteriovenous malformation (AVM) or cerebral aneurysm Use of any recreational drugs or history of drug addiction Pregnant or breast-feeding women The receipt of an investigational drug, or participation in a drug research study within a period of one month prior to the first FUS exposure Known sensitivity/allergy to MRI contrast agents, CT contrast agents, SonoVue®, or any of its components 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 Abnormal baseline findings considered by the investigator to indicate conditions that might affect study endpoints Patients who have hemorrhage or cyst within the ROI Severe hypertension at screening (diastolic blood pressure > 100 mmHg on medication) Receiving anticoagulant (e.g. warfarin) or antiplatelet (e.g. aspirin) therapy within one week prior to study treatment or drugs known to increase risk or hemorrhage (e.g. Avastin) within one month prior to study treatment
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
Undecided
IPD Sharing Plan Description
Undecided
Citations:
PubMed Identifier
22723060
Citation
Wei KC, Tsai HC, Lu YJ, Yang HW, Hua MY, Wu MF, Chen PY, Huang CY, Yen TC, Liu HL. Neuronavigation-guided focused ultrasound-induced blood-brain barrier opening: a preliminary study in swine. AJNR Am J Neuroradiol. 2013 Jan;34(1):115-20. doi: 10.3174/ajnr.A3150. Epub 2012 Jun 21.
Results Reference
background
PubMed Identifier
21645965
Citation
McDannold N, Zhang Y, Vykhodtseva N. Blood-brain barrier disruption and vascular damage induced by ultrasound bursts combined with microbubbles can be influenced by choice of anesthesia protocol. Ultrasound Med Biol. 2011 Aug;37(8):1259-70. doi: 10.1016/j.ultrasmedbio.2011.04.019. Epub 2011 Jun 8.
Results Reference
background
PubMed Identifier
18313204
Citation
Liu HL, Wai YY, Chen WS, Chen JC, Hsu PH, Wu XY, Huang WC, Yen TC, Wang JJ. Hemorrhage detection during focused-ultrasound induced blood-brain-barrier opening by using susceptibility-weighted magnetic resonance imaging. Ultrasound Med Biol. 2008 Apr;34(4):598-606. doi: 10.1016/j.ultrasmedbio.2008.01.011. Epub 2008 Mar 3.
Results Reference
background
PubMed Identifier
15588592
Citation
Hynynen K, McDannold N, Sheikov NA, Jolesz FA, Vykhodtseva N. Local and reversible blood-brain barrier disruption by noninvasive focused ultrasound at frequencies suitable for trans-skull sonications. Neuroimage. 2005 Jan 1;24(1):12-20. doi: 10.1016/j.neuroimage.2004.06.046.
Results Reference
background
PubMed Identifier
23527068
Citation
Wei KC, Chu PC, Wang HY, Huang CY, Chen PY, Tsai HC, Lu YJ, Lee PY, Tseng IC, Feng LY, Hsu PW, Yen TC, Liu HL. Focused ultrasound-induced blood-brain barrier opening to enhance temozolomide delivery for glioblastoma treatment: a preclinical study. PLoS One. 2013;8(3):e58995. doi: 10.1371/journal.pone.0058995. Epub 2013 Mar 19.
Results Reference
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Safety of BBB Disruption Using NaviFUS System in Recurrent Glioblastoma Multiforme (GBM) Patients

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