Ultrasound-based Blood-brain Barrier Opening and Albumin-bound Paclitaxel for Recurrent Glioblastoma

  • End date
    Sep 25, 2025
  • participants needed
  • sponsor
    Northwestern University
Updated on 25 January 2021
karnofsky performance status
glioblastoma multiforme
recurrent glioblastoma
contrast-enhanced magnetic resonance imaging
recurrent tumor


Paclitaxel is among the most active agents against glioblastoma in preclinical models. However, its clinical use has been hampered by the blood-brain barrier (BBB). In this trial we will implant a novel device with 9 ultrasound emitters allowing to temporarily and reversibly open the BBB immediately prior to chemotherapy infusion with albumin-bound paclitaxel.

In this phase 1 trial increasing doses of chemotherapy will be delivered as long deemed safe and prior patient had not experienced severe toxicity. Once the the recommended dosing has been established, additional patients will be treated in order to better evaluate the antitumor efficacy of this novel treatment.

The device will be implanted at the time of surgical resection of the recurrent tumor. During that procedure a first test dose of the chemotherapy will be administered in the operating room after sonication (procedure of activating ultrasound and opening the BBB) and tissue concentrations in different parts of the resected tumor will be measured. In select patients, the sonication procedure will occur immediately after the test dose of chemotherapy is administered.

The objectives of this trial are to establish a safe and effective dose of ABX, to demonstrate that the opening of the BBB increases chemotherapy concentration in the tumor, and to estimate how effective this treatment is in reducing the tumor burden and prolonging life.


Eligible patients will undergo craniotomy for tumor resection. During the tumor resection, an initial low dose of paclitaxel will be given following sonication. In select patients, the sonication procedure will occur immediately after the test dose of chemotherapy is administered.The sonication device will be implanted at the end of the procedure. About two weeks after surgery, patients will undergo sonication and albumin-bound paclitaxel administration with MRI to quantify extent of blood brain barrier opening. Sonication and administration of albumin-bound paclitaxel will continue every 3 weeks until disease progression. The planned ABX starting dose is 40 mg/m2 of ABX, to be escalated in the absence of significant toxicity up to 260 mg/m2. Blood samples for circulating tumor DNA will also be collected before and after each sonication.

Condition Glioma, gliosarcoma, Glioblastoma Multiforme, Glomerular Basement Membrane, Recurrent Glioblastoma, Gliomas, Glioblastoma, IDH-wildtype, Glioblastoma, IDH-wildtype, glioblastoma, Glioblastoma, IDH-wildtype
Treatment Sonication for opening of blood-brain barrier, Chemotherapy, albumin-bound paclitaxel
Clinical Study IdentifierNCT04528680
SponsorNorthwestern University
Last Modified on25 January 2021


Yes No Not Sure

Inclusion Criteria

Confirmed diagnosis of Isocitrate Dehydrogenase 1 (IDH1) wild-type glioblastoma on pathology from initial surgery (e.g. IDH R132H neg)
Ability to undergo contrast-enhanced MRI
Radiographic evidence of tumor recurrence/progression after failure of 1 - 2 lines of prior therapy
Measurable or evaluable disease
Measurable: contrast-enhancement (bidirectional diameters 1cm) on MRI
Non-measurable/evaluable: contrast-enhancement diameters < 1 cm
Maximal tumor diameter pre-surgery 70 mm on T1wMRI
Candidate for at least partial surgical resection
Greater 12 weeks from completion of radiation therapy
Age 18 years
Stable or decreasing dose of corticosteroids equivalent to 6 mg dexamethasone, for 7 days prior to registration
WHO performance status 2 (equivalent to Karnofsky Performance Status (KPS) of 70)
Adequate hepatic, renal and bone marrow function, documented with normal laboratory values or no more than grade 1 outside the norm performed within 14 days prior to registration
For patients with a childbearing potential
Negative pregnancy test within 14 days prior to registration
Agreement to use adequate contraception for the duration of study participation, and for 3 and 6 months after the last dose of nab-paclitaxel for men and women of childbearing potential, respectively
Have the ability to understand and the willingness to sign a written informed consent prior to registration on study
Be willing and able to comply with the protocol for the duration of the study
Provide written, signed and dated informed consent prior to study registration. NOTE: no study-specific screening procedures may be performed until written consent has been obtained

Exclusion Criteria

Have multifocal disease that cannot be encompassed in the ultrasound fields
e.g. > 70-mm apart
tumor located in the posterior fossa
Patients at risk of cranial wound dehiscence
Have uncontrolled epilepsy or require treatment with enzyme-inducing antiepileptics
Have clinical evidence of peripheral neuropathy on examination
Have received any other investigational agents within 4 weeks of registration
Have received prior therapy with or have history of allergic reactions attributed to compounds of similar chemical or biologic composition to paclitaxel
Medical contraindications to Abraxane
Have an uncontrolled intercurrent illness
Are pregnant or nursing
Have a history of active malignancy within 3 years prior to registration
Have a known history of hypersensitivity reactions to perflutren lipid microsphere components or to any of the inactive ingredients in Definity (the FDA-approved ultrasound contrast agent to be used in this study)
Patients with coils, clips, shunts, intravascular stents, and/or non-removable wafer, non resorbable dura substitute, or reservoirs
Patients with medical need to continue antiplatelet therapy
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