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JOURNAL ONKOLOGIE – STUDIE

SonoFIRST Innovative SonoCloud-9 Device for Blood Brain Barrier Opening in First Line Temozolomide Glioblastoma Patients.

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NCT-Nummer:
NCT04614493

Studienbeginn:
November 2020

Letztes Update:
04.11.2020

Wirkstoff:
Temozolomide according Stupp protocol

Indikation (Clinical Trials):
Glioblastoma

Geschlecht:
Alle

Altersgruppe:
Erwachsene (18+)

Phase:
Phase 2

Sponsor:
Assistance Publique - Hôpitaux de Paris

Collaborator:
-

Studienleiter

Ahmed IDBAIH, MD, PhD
Principal Investigator
APHP-Sorbonne, Pitie Salpetriere Hospital, Paris

Kontakt

Studienlocations (3 von 7)

APHP-Sorbonne, Pitié Salpêtrière Hospital
75013 Paris
France» Google-Maps
Ansprechpartner:
Ahmed IDBAIH, MD, PhD
Phone: 33 1 42 16 03 85
E-Mail: ahmed.idbaih@aphp.fr

Alexandre CARPENTIER, MD, PhD
Phone: 33 1 42 16 34 05
E-Mail: alexandre.carpentier@aphp.fr
» Ansprechpartner anzeigen
Alle anzeigen

Studien-Informationen

Detailed Description:

This will be an open-label, Phase 2, multicenter, double arm, randomized, interventional

trial that will evaluate primarily the clinical efficacy of the device and will be to compare

Progression Free Survival (PFS) between the standard of care treatment with concomitant

ultrasound BBB opening versus standard of care alone. Glioblastoma (GBM) is the most common

and aggressive primary brain cancer. Currently, prognosis is very poor, with a survival of

about 15 months with current therapies. Although intensive treatments combining surgery,

radiotherapy and chemotherapy, the prognosis of GBM patients remains poor. New treatment

strategies are urgently needed.

In the brain, the presence of the blood-brain barrier (BBB) limits the uptake of therapeutic

agents. To encounter this BBB issue, Professor Alexandre Carpentier and his team developed an

ultrasound medical device (SonoCloud), implanted in the skull during surgery. This highly

innovative technique temporarily permeates the BBB, increasing drug delivery to the brain by

five times. The SonoCloud, a low-intensity pulsed ultrasound device developed by CarThera, is

one of the major innovations in this field, as shown by the encouraging results obtained in

studies in recurrent GBM.

The expected benefits of using the SonoCloud-9 experimental device prior to TMZ chemotherapy

are the stabilization or reduction of GBM tumor volume on the one hand, and stabilization or

improvement of the patient's neurological status on the other hand.

Participation in the clinical trial will contribute to a better understanding of the safety

and efficacy of opening the BBB. It will be possible to determine whether the BBB opening

using low-intensity pulsed ultrasound can be effective in treating GBM, in addition to the

standard of care protocol.

Ein-/Ausschlusskriterien

Inclusion Criteria :

1. Age ≥ 18 years and ≤ 70 years, able and willing to give signed and informed consent

2. MRI with suspicion of GBM or Patient with a newly histologically proven IDHwt GBM by

previous stereotaxic biopsy or king size opened biopsy

3. Karnofsky Performance Status ≥ 70

4. Patient eligible for a total or sub-total surgical tumor resection

5. Maximal tumor enhancement diameter at inclusion (pre surgery) ≤ 70 mm in T1W MRI

6. Patient eligible after surgery for the first line standard of care temoradiation and

adjuvant TMZ (Stupp protocol, 54)

7. Patient with adequate organ and bone marrow function within 14 days prior to

registration, as defined below:

- Hemoglobin ≥ 10.0 g/dL

- Leukocytes ≥ 3,000/L

- Absolute neutrophil count ≥ 1,500/L

- Platelets ≥ 100,000/L

- Total bilirubin < 1.5 x ULN

- AST(SGOT)/ALT(SPGT) ≤ 3 x institutional ULN

- Alkaline phosphatase (ALP) < 3 x ULN

- Normal creatine clearance ≥ 60 mL/minute.

- Prothrombin time and partial thromboplastin time within institutional limits.

8. For women of childbearing potential, a negative pregnancy test before inclusion and a

medically acceptable method of birth control used throughout the study are required. A

female patient is eligible to participate if she is not pregnant, not breastfeeding,

and at least 1 of the following conditions applies: Not a woman of childbearing

potential (WOCBP) OR A WOCBP who agrees to follow the contraceptive guidance during

the treatment period and for at least 1 month after the end of study visit

9. A male patient must agree to use contraception as detailed in this Protocol during the

treatment period and for at least 6 months after the last cycle of TMZ; he must

refrain from donating sperm during this period

10. Patient capable of giving signed informed consent, which includes compliance with the

requirements and restrictions listed in the Informed Consent Form (ICF) and in this

protocol

11. Patient must be a beneficiary of or affiliated with a social security scheme

Exclusion Criteria :

1. Patients with multifocal tumor (unless all localized in a 70 mm diameter area

accessible to ultrasound field) or located in posterior fossa tumor

2. Patient with diffuse FLAIR abnormalities attributable to Gliomatosis

3. Patients with evidence of uncontrolled intracranial pressure

4. Patients with uncontrolled epilepsy

5. Patients with medical need to continue antiplatelet or antithrombotic treatment

6. Pregnant or breastfeeding women (blood pregnancy test)

7. Patients with contra-indications to MRI or known sensitivity/allergy to gadolinium, or

other intravascular contrast agents

8. Known history of hypersensitivity reactions to perflutren lipid microsphere components

or to any of the inactive ingredients in Luminity®/Definity®

9. Patients with known intracranial aneurism, with and/or unremovable coils, clips,

shunts, intravascular stents, wafer, non resorbable dura substitute, or reservoirs

10. Patients with an uncontrolled intercurrent illness or any pre-existing comorbidities

that in the Investigator's opinion may prevent the implantation of the device or may

impair the ability of the patient to receive treatment with SonoCloud or may be

cofounding for evaluation of the clinical trial.

11. Patients with the following are not eligible:

- Known arterial hypertension grade 3 or higher without adequate control on

medications

- Known or suspected unstable active or chronic infections requiring systemic

treatment

- Known significant cardiac disease: right-to-left shunts, Unstable angina

pectoris, Symptomatic congestive heart failure, Unstable cardiac arrhythmia

- Known significant pulmonary disease: severe pulmonary hypertension (pulmonary

artery pressure > 90 mmHg), uncontrolled systemic hypertension, adult respiratory

distress syndrome, or Pneumonitis

- Known Severe renal failure

- Known serious myelosuppression

- Known Psychiatric illness/social situations that would limit compliance with

study requirements

- Any other illness or condition that the treating investigator feels would

interfere with study compliance or would compromise the patient's safety or study

endpoints

- Known immunodeficiency disease or treatments (HIV)

- Known viral or bacterial chronic/acute disease (potential blood borne infections

that could result in meningitis or brain abscess)

12. Patients under judicial protection

13. Patients with any following prohibited treatments:

- Any investigational medicinal product within 30 days prior to inclusion and

during the study

- Antibiotics with known neurotoxicity (eg, aminoglycosides, cephalosporin,

quinolones), unless substitution is not possible,

- Non-absorbable material (dura matter substitute, hemostatic agent…)

- Any other drug according investigator to cause cerebral toxicity due to BBB

opening

- Contra-indications to temozolomide

- Dacarbazine hypersensitivity

14. Implantation of the SC-9 not possible according to neurosurgeon (any patient

morphological characteristics (e.g. skin thin thickness >9mm), which, from

neurosurgeons' opinion, prevent implantation of the device or may impair the ability

of the patient to receive treatment with SonoCloud, would be excluded)

Studien-Rationale

Primary outcome:

1. Progression Free Survival (PFS), PFS is defined as the time between randomization and disease progression which is the first documented tumor progression (per local Investigator assessment according to the RANO criteria) or death due to any cause. (Time Frame - Between randomisation and 18 months after the last inclusion.):
Progression will be assessed by local investigator according to the RANO criteria



Secondary outcome:

1. Overall Survival improvement (OS) (Time Frame - Between randomisation and 18 months after the last inclusion.):
OS is defined as the time from the date of randomization to the date of death due to any cause.

2. central review Progression Free Survival (crPFS) (Time Frame - Between randomisation and 18 months after the last inclusion.):
The central review Progression Free Survival is evaluated by a central assessment (independent imaging core lab) at the end of study and is defined as the time between randomization and tumor progression which is the first documented tumor progression according to the radiological RANO criteria or death due to any cause

3. immune Progression Free Survival (iPFS) (Time Frame - Between randomisation and 18 months after the last inclusion.):
The iPFS is evaluated according to iRANO (immune-related modifications / pseudo-progression ) criteria assessed by local investigator

4. Mean score of Patient quality of life preservation - EORTC Quality of Life Questionnaire C30 (Time Frame - Before surgery, pre-TemoRadiation visit, Cycle 1 (baseline after surgery/radiotherapy, 1 cycle = 28 days), Cycle 3, Cycle 6, Month 11 and Month 18, or until progression up to 18 months):
Quality of Life Questionnaire (QLQ) according to the European Organization for Research and Treatment of Cancer will be assessed by mean scores of the EORTC QLQ C-30 questionnaire (30 questions, score from 30 to 126) by local investigator or nurses and patient

5. Mean score Patient quality of life preservation - BN20 Quality of Life Questionnaire (Time Frame - Before surgery, pre-TemoRadiation visit, Cycle1 (baseline after surgery/radiotherapy, 1 cycle = 28 days), Cycle 3, Cycle 6, Month 11, Month 18, or until progression up to 18 months):
Quality of Life Questionnaire (QLQ) according to the European Organization for Research and Treatment of Cancer will be assessed will be assessed by means of the EORTC BN20 questionnaire (30 questions, score from 1 to 80) by local investigator or nurses and patient

6. Karnofsky Performance Status (KPS) (Time Frame - Before surgery, Surgery (+/- device implantation), pre-TemoRadiation visit, start and day 15 of each cycle (=28 days) from Cycle 1 to 6, Month 11, Month 13, Month 15, or until progression up to 18 months, new surgery (debulking or device explantation))

7. Mean score of Patient cognitive preservation (Time Frame - Before surgery, pre-TemoRadiation visit, Cycle1 (baseline after surgery/radiotherapy, 1 cycle = 28 days), Cycle 3, Cycle 6, Month 11, Month 18, or until progression up to 18 months):
Mini Mental Status Examination (30-point questionnaire, score from 1 to 30) mean score assessed by local investigator or nurses and patient

8. Visual analogic scale (VAS) Pain score from surgical area (Time Frame - Before surgery, pre-TemoRadiation visit, Cycle1 (baseline after surgery/radiotherapy, 1 cycle = 28 days), Cycle 3, Cycle 6, Month 11, Month 18, or until progression up to 18 months):
pain score from surgical area using visual analogic scale (score 0 to 10. Zero indicates the absence of pain, while 10 represents the most intense pain possible).

9. Esthetical (Time Frame - Before surgery, pre-TemoRadiation visit, Cycle1 (baseline after surgery/radiotherapy, 1 cycle = 28 days), Cycle 3, Cycle 6, Month 11, Month 18, or until progression up to 18 months):
score in self-confidence concerning esthetical dimension of surgical scar using esthetical comfort question equivalent to q39 of QLQ-BR23 questionnaire: Does your skull scar induce any esthetic burden to you? Not at all A little Quite a bit Very much

10. Safety : Type, frequency and severity of adverse events and serious adverse events (Time Frame - From inclusion to end of treatment, up to 18 months):
Safety confirmation of efficient blood brain barrier opening procedure with the SonoCloud-9 system. Safety confirmation is assessed by the frequency and severity of Adverse Events (AE) (incidence of AE summarized by system organ class and/or preferred term and severity) based on the Common Terminology Criteria for Adverse Events, version 5.0.

Studien-Arme

  • Experimental: Ultrasound experimental arm
    Standard of Care + 15 Ultrasound BBB opening
  • Other: Control arm
    Standard of Care

Geprüfte Regime

  • SonoCloud-9 (SC9) device:
    daily temozolomide (TMZ) during Radiation, followed by 6 months of adjuvant TMZ (5 days/months) with 6 concomitant Blood Brain Barrier opening sessions by ultrasound + 9 Blood Brain Barrier opening sessions by ultrasound without any associated drug
  • Temozolomide according Stupp protocol:
    daily temozolomide (TMZ) during Radiation, followed by 6 months of adjuvant TMZ (5 days/months)

Quelle: ClinicalTrials.gov


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