Blood Brain Barrier (BBB) Disruption Using Exablate Focused Ultrasound With Doxorubicin for Treatment of Pediatric DIPG

Trial Title: Blood Brain Barrier (BBB) Disruption Using Exablate Focused Ultrasound With Doxorubicin for Treatment of Pediatric DIPG

NCT ID: NCT05630209

Condition: Brain Tumor

Conditions: Official terms:
Brain Neoplasms
Doxorubicin

Conditions: Keywords:
DIPG
Focused Ultrasound
Chemotherapy
Phase I trial
Pediatrics

Study type: Interventional

Study phase: Phase 1/Phase 2

Overall status: Recruiting

Study design:

Allocation: N/A

Intervention model: Single Group Assignment

Primary purpose: Device Feasibility

Masking: None (Open Label)

Intervention:

Intervention type: Device
Intervention name: Exablate
Description: Blood Brain Barrier Disruption (BBBD) via Exablate Type 2 system with microbubble resonators on the day of Doxorubicin infusion to treat DIPG brain tumors
Arm group label: Blood Brain Barrier Disruption (BBBD)

Other name: Exablate BBBD

Intervention type: Drug
Intervention name: Doxorubicin
Description: Doxorubicin infusion
Arm group label: Blood Brain Barrier Disruption (BBBD)

Other name: Adriamycin

Other name: Rubex

Summary: The purpose of this study is to evaluate the safety and efficacy of targeted blood brain barrier disruption with Exablate Model 4000 Type2.0/2.1 in combination with Doxorubicin therapy for the treatment of DIPG in pediatric patients

Detailed description: This is a prospective, single arm, non-randomized feasibility study to evaluate the safety, feasibility and preliminary efficacy of Blood Brain Barrier Disruption (BBBD) using the Exablate Type 2 system in pediatric patients with Diffuse Intrinsic Pontine Gliomas (DIPG)undergoing Doxorubicin chemotherapy. The study will be conducted at up to three sites in the United States. Patients will undergo 3 treatment cycles, approximately 4 -6 weeks apart. The study aims to establish feasibility and safety of Exablate BBBD in conjunction with Doxorubicin in the treatment of pediatric DIPG and assess preliminary efficacy in this patient population.

Criteria for eligibility:
Criteria:
Inclusion Criteria: - Age between 5 and 21 years, inclusive - Patient diagnosed with DIPG - At least 4-week and not greater than 12 weeks from completion of radiation therapy - Post-radiation imaging does not show evidence of necrosis/ hemorrhage or other features that contraindicate MRgFUS - If brain surgery occurred, at least 14 days passed since last brain surgery and the patient is fully recovered and neurologically stable - If on steroids, stable or decreasing dose for at least 7 days prior to study entry - Stable or improving neurologic status for 7 days prior to study entry - Able and willing to give consent and/or assent or have a legal guardian who is able and willing to do so - Able to attend all study visits and with life expectancy of at least 6 months Exclusion Criteria: - Tumor not visible on any pre-therapy or post-radiation imaging - Previous participation in other chemotherapy, molecularly targeted therapy, or immunotherapy treatment-related phase 1 or 2 trials - Symptoms and signs of increased intracranial pressure - Subject with metastatic disease - Subject with ventricular peritoneal shunt - Subject receiving bevacizumab (Avastin) therapy or increasing doses of steroids - Anti-coagulant therapy, or medications known to increase risk of hemorrhage, (e.g., ASA, non-steroidal anti-inflammatory drugs [NSAIDs], statins) within washout period prior to treatment - History of a bleeding disorder, coagulopathy or with a history of spontaneous tumor hemorrhage. - Hypertension per age - Cerebral or systemic vasculopathy, including intracranial thrombosis, vascular malformation, cerebral aneurysm, or vasculitis - Immunosuppression (corticosteroids to prevent/treat brain edema are permitted). - Patients with positive HIV status - Active seizure disorder or epilepsy (seizures despite medical treatment) for a minimum of 4 weeks prior to first cycle/Exablate BBBD procedure captured by history - Known sensitivity to gadolinium-based contrast agents - Known sensitivity to DEFINITY® ultrasound contrast agent or known hypersensitivity to perflutren microsphere or its components, e.g., polyethylene glycol - Contraindication to Doxorubicin - Previous treatment with complete cumulative doses of Doxorubicin, daunorubicin, idarubicin, and/or other anthracyclines and anthracenediones - Severely impaired renal function with estimated glomerular filtration rate <2 standard deviations for age - Patients that may require trastuzumab during the study - Patients that may require inhibitors and inducers of CYP3A4, CYP2D6, and/or P-gp during the study

Gender: All

Minimum age: 5 Years

Maximum age: 21 Years

Healthy volunteers: No

Locations:

Facility:
Name: Children's National Medical Center

Address:
City: Washington
Zip: 20010
Country: United States

Status: Recruiting

Contact:
Last name: Elizabeth Paronett

Phone: 202-476-5551
Email: eparonett@childrensnational.org

Investigator:
Last name: Roger Packer
Email: Principal Investigator

Investigator:
Last name: Robert Keating
Email: Sub-Investigator

Facility:
Name: Nicklaus Children's Hospital

Address:
City: Miami
Zip: 33155
Country: United States

Status: Recruiting

Contact:
Last name: Toba Niazi, MD

Phone: 305-662-8386
Email: Toba.niazi@nicklaushealth.org

Contact backup:
Last name: Ana Diaz, ARNP
Email: DIPG.ClinicalTrial@nicklaushealth.org

Investigator:
Last name: Toba Niazi, MD
Email: Principal Investigator

Start date: January 4, 2023

Completion date: January 2026

Lead sponsor:
Agency: InSightec
Agency class: Industry

Source: InSightec

Record processing date: ClinicalTrials.gov processed this data on November 12, 2024

Source: ClinicalTrials.gov page: https://clinicaltrials.gov/ct2/show/NCT05630209