💬In plain words
What the trial is, and whether it could suit you
This is an open-label phase 1 safety and feasibility study evaluating a novel combination therapy for Diffuse Midline Glioma (DMG), an aggressive brain tumor with a very poor prognosis - an average one-year overall survival. This study combines blood-brain barrier (BBB) disruption (BBBD) using low-intensity focused ultrasound (LIFU) and microbubble treatment, and intravenous infusion of autologous, tumor multi-antigen associated specific cytotoxic T lymphocyte (TAA-T) therapy. The TAA-T cell investigational product in this protocol is manufactured to target Preferentially Expressed Antigen of Melanoma (PRAME), Wilms Tumor 1 (WT1), and survivin.
Sign in to get the eligibility rules as simple questions to take to your doctor.
📋 Eligibility rules (as published)
Inclusion Criteria:
Inclusion Criteria for Screening and Procurement:
* Age ≥ 3 and ≤ 25 years
* Diagnosis of pontine or thalamic DMG
* Group A: newly diagnosed pontine DMG after completion of standard radiation therapy; radiographic diagnosis is defined as tumors with a pontine epicenter and diffuse intrinsic involvement of the pons - tissue diagnosis is not required
* Group B: newly diagnosed thalamic DMG after completion of standard radiation therapy; tissue diagnosis is required NOTE: Tumor extending outside of the pons or the thalamus can remain eligible if the LIFU treatment is not contraindicated based on the neurosurgeon's assessment and the tumor does not meet any of the exclusion criteria below
* The first procurement blood draw must occur between 4 and 14 weeks after completion of radiation therapy for Group A, and between 4 and 22 weeks after completion of radiation therapy for Group B
* Lansky/Karnofsky rating ≥ 60 (participants who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for purposes of assessing performance status)
* Head circumference ≥ 49 cm
* Organ function:
* Hemoglobin ≥ 8 g/dL, unsupported
* Absolute Neutrophil Count (ANC) ≥750/μL
* Absolute Lymphocyte Count (ALC) \>500/μL
* Platelets ≥75K, unsupported
* Total Bilirubin ≤3x upper limit of normal (ULN)
* AST/ALT ≤5x ULN
* Serum creatinine ≤1.0 mg/dL or ≤1.5x ULN for age (whichever is higher)
* Pulse oximetry \>90% on room air
* If the participant is on corticosteroids, the dose must be stable or decreasing for at least 7 days prior to procurement, and the treating investigator must anticipate that steroids can be weaned to ≤ 0.4 mg/m2/day of dexamethasone or equivalent by the start of the first LIFT protocol therapy cycle
* Deemed to be of sufficient size (≥10 kg) to provide the necessary blood volume for TAA-T generation with no contra-indications to research blood draw, as determined by the treating PI/Sub-I
* Adult participant or LAR of minor participant demonstrates willingness to have intracerebroventricular access device placed prior to initiation of LIFT protocol therapy, if a suitable Rickham, Ommaya, or accessible VP shunt is not already in place at study entry
* For females of childbearing potential (FOCBP): negative pregnancy test within 7 days prior to procurement (urine or serum)
* Adult participant or LAR of minor participant capable of providing informed consent. When appropriate, pediatric participants ≥7 years of age will participate in an age-appropriate discussion and provide assent, unless an IRB-approved waiver of assent applies and documentation of the participant's eligibility for the waiver is maintained
Inclusion Criteria for BBBD Procedure and TAA-T Infusion:
* Lansky/Karnofsky rating ≥ 60 (participants who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for purposes of assessing performance status)
* Group A: must have their initial planned LIFU and TAA-T infusion within 20 weeks from completion of radiation therapy; Group B: must have their initial planned LIFU and TAA-T infusion within 28 weeks from completion of radiation therapy
* For participant with a history of prior intracranial surgery, at least 14 days must have elapsed since surgery and the participant must have fully recovered from acute surgical effects
* For participant with a history of bevacizumab (Avastin) exposure, at least 28 days must have elapsed since the last dose
* If on steroids, stable or decreasing dose ≤ 0.4 mg/m2/day of dexamethasone or equivalent on the date of eligibility confirmation for LIFT treatment
* Stable or improving neurological status for ≥14 days prior to the date of eligibility confirmation for the first LIFU and TAA-T infusion, and for ≥7 days prior to the date of eligibility confirmation for subsequent cycles
* Intracerebroventricular access device (such as an Ommaya or Rickham reservoir and catheter) or VP shunt present, and in a location that does not interfere with Exablate BBBD procedure
* Organ function:
* Hemoglobin ≥ 8 g/dL, unsupported
* Absolute Neutrophil Count (ANC) ≥750/μL
* Platelets ≥75K, unsupported
* Normal coagulation studies: PT (\<14 sec) or PTT (\<36 sec), and INR (\<1.2)
* Total Bilirubin ≤3x upper limit of normal (ULN)
* AST/ALT ≤5x ULN
* Serum creatinine ≤1.0mg/dL or ≤1.5x ULN for age (whichever is higher)
* Pulse oximetry \>90% on room air
* For FOCBP: negative pregnancy test (urine or serum)
* Agree to use contraceptive measures for at least 6 months following final TAA-T infusion (when age appropriate)
* Suitability for prolonged anesthesia for LIFU procedure, in the opinion of treating PI or qualified Sub-I
* Agree to a brief course of steroids or bevacizumab or anti-cytokine agent/s if the treating investigator deems it clinically necessary in the context of clinical deterioration that may be attributed to the LIFT protocol therapy
* Adult participant or LAR of a minor participant capable of providing informed consent. When appropriate, pediatric participants ≥7 years of age will participate in an age-appropriate discussion and provide assent, unless an IRB-approved waiver of assent applies and documentation of the participant's eligibility for the waiver is maintained
* Adult participant or LAR of a minor participant must attest to the participant's ability to remain in close geographic proximity to CNH (within 60-mile radius) for the initial dose limiting toxicity (DLT) monitoring period, and for the first 14 days after each subsequent infusion
Exclusion Criteria:
Exclusion Criteria for Screening and Procurement:
* Tumor not visible on any pre-LIFT therapy imaging
* Previous participation in other conventional or investigational chemotherapy, molecularly targeted therapy, or immunotherapy (Exceptions: Temozolomide during radiation in Group B patients is allowed; Bevacizumab use is allowed)
* Disseminated di